Provider Demographics
NPI:1588835391
Name:CHARBONNEAU, SARAH E (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:CHARBONNEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026A WEST CARY STREET
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221
Mailing Address - Country:US
Mailing Address - Phone:804-305-6536
Mailing Address - Fax:804-727-8580
Practice Address - Street 1:3026A WEST CARY STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221
Practice Address - Country:US
Practice Address - Phone:804-305-6536
Practice Address - Fax:804-727-8580
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA349678OtherANTHEM
VAO803824MOtherOPTIMA
VA016901H79Medicare PIN