Provider Demographics
NPI:1679049464
Name:SAGESTONE PLLC
Entity Type:Organization
Organization Name:SAGESTONE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIASCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPCA LCASA
Authorized Official - Phone:252-515-0557
Mailing Address - Street 1:PO BOX 5605
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-5605
Mailing Address - Country:US
Mailing Address - Phone:252-515-0557
Mailing Address - Fax:
Practice Address - Street 1:8101 EMERALD DR STE B
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2716
Practice Address - Country:US
Practice Address - Phone:252-515-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care