Provider Demographics
NPI:1659730208
Name:STOLLE, SARAH ELYSE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELYSE
Last Name:STOLLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 DWYER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6921
Mailing Address - Country:US
Mailing Address - Phone:757-615-3003
Mailing Address - Fax:
Practice Address - Street 1:700 DWYER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-6921
Practice Address - Country:US
Practice Address - Phone:757-615-3003
Practice Address - Fax:757-243-1262
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000700103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst