Provider Demographics
NPI:1679753214
Name:GROARK, SARA WANNER (LPC,LMFT,CSAC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:WANNER
Last Name:GROARK
Suffix:
Gender:F
Credentials:LPC,LMFT,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6842 ELM ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3891
Mailing Address - Country:US
Mailing Address - Phone:703-855-1312
Mailing Address - Fax:703-356-3461
Practice Address - Street 1:6842 ELM ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3891
Practice Address - Country:US
Practice Address - Phone:703-855-1312
Practice Address - Fax:703-356-3461
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001190101YA0400X
VA0701002267101YM0800X
VA0717000190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health