Provider Demographics
NPI:1891868261
Name:CHISHOLM-STOCKARD, SARAH M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:M
Last Name:CHISHOLM-STOCKARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42106
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21284-2106
Mailing Address - Country:US
Mailing Address - Phone:443-797-2530
Mailing Address - Fax:
Practice Address - Street 1:320 E TOWSONTOWN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5323
Practice Address - Country:US
Practice Address - Phone:443-797-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical