Provider Demographics
NPI:1619521572
Name:BALDWIN, SARA (CIT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SUWANEE DAM RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8702
Mailing Address - Country:US
Mailing Address - Phone:404-358-1704
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD STE 310
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8702
Practice Address - Country:US
Practice Address - Phone:404-358-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor