Provider Demographics
NPI:1972876787
Name:PASCUCCI, SARA (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PASCUCCI
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ENDICOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC, LPC
Mailing Address - Street 1:1708 TRAWICK RD, STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604
Mailing Address - Country:US
Mailing Address - Phone:919-256-0824
Mailing Address - Fax:919-256-0833
Practice Address - Street 1:1708 TRAWICK RD, STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604
Practice Address - Country:US
Practice Address - Phone:919-641-2322
Practice Address - Fax:919-852-5323
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8414101YM0800X
NC8414104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCMC128496Medicaid