Provider Demographics
NPI:1851041339
Name:PAYNE, SARAH MARIE GRAHAM (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE GRAHAM
Last Name:PAYNE
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 1:108 WESTON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4213
Mailing Address - Country:US
Mailing Address - Phone:570-466-4986
Mailing Address - Fax:
Practice Address - Street 1:108 WESTON CT
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-4213
Practice Address - Country:US
Practice Address - Phone:570-466-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional