Provider Demographics
NPI:1609846914
Name:ADDISON, SARAH (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ADDISON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APC
Mailing Address - Street 1:138 JASON POND WAY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-7247
Mailing Address - Country:US
Mailing Address - Phone:678-231-5557
Mailing Address - Fax:706-850-0899
Practice Address - Street 1:5415 THOMPSON MILL RD
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-4132
Practice Address - Country:US
Practice Address - Phone:678-231-5557
Practice Address - Fax:706-850-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA619348603AMedicaid