Provider Demographics
NPI:1639655657
Name:COCOWITCH, SARAH DAVIDSON (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DAVIDSON
Last Name:COCOWITCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 WYCLIFFE AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2335
Mailing Address - Country:US
Mailing Address - Phone:415-810-2118
Mailing Address - Fax:
Practice Address - Street 1:811 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5165
Practice Address - Country:US
Practice Address - Phone:540-387-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health