Provider Demographics
NPI:1861010035
Name:FORD, SARA SCOTT (LCMHCA, CRC, CSP)
Entity Type:Individual
Prefix:
First Name:SARA SCOTT
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LCMHCA, CRC, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 MARKET ST STE 6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1426
Mailing Address - Country:US
Mailing Address - Phone:910-777-5575
Mailing Address - Fax:910-777-5273
Practice Address - Street 1:3825 MARKET ST STE 6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1426
Practice Address - Country:US
Practice Address - Phone:910-777-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15456101Y00000X, 101YM0800X, 101YP2500X
NC00237454225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor