Provider Demographics
NPI:1891312229
Name:ABERCROMBIE, SARA ASHLEY (BA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEY
Last Name:ABERCROMBIE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6417
Mailing Address - Country:US
Mailing Address - Phone:770-833-5762
Mailing Address - Fax:
Practice Address - Street 1:1274 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-4211
Practice Address - Country:US
Practice Address - Phone:770-833-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-67850103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst