Provider Demographics
NPI:1548213804
Name:ROSENQUIST, SARA ELLEN (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELLEN
Last Name:ROSENQUIST
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5815 CAMEO GLASS WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3076
Mailing Address - Country:US
Mailing Address - Phone:919-260-0762
Mailing Address - Fax:866-919-4850
Practice Address - Street 1:120 PROVIDENCE RD STE 7A
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2273
Practice Address - Country:US
Practice Address - Phone:866-337-4911
Practice Address - Fax:866-919-4850
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC-165267OtherCAREFIRST
NC0424EOtherBCBS PROVIDER NUMBER