Provider Demographics
NPI:1982849303
Name:POWELL, SARAH LESLEY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LESLEY
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:LESLEY
Other - Last Name:WEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2425 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7903
Mailing Address - Country:US
Mailing Address - Phone:910-313-2213
Mailing Address - Fax:910-313-6598
Practice Address - Street 1:2425 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7903
Practice Address - Country:US
Practice Address - Phone:910-313-2213
Practice Address - Fax:910-313-6598
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104135Medicaid