Provider Demographics
NPI:1679187009
Name:FLETCHER, SARAH NICOLE (LMHCA, CN)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:NICOLE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LMHCA, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 MARINE VIEW DR S STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22525 MARINE VIEW DR S STE 200
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6879
Practice Address - Country:US
Practice Address - Phone:206-762-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61089256133N00000X
WAMC61090290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist