Provider Demographics
NPI:1205628195
Name:WALLACE, SARAH (LCAS-A)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 GLENHARDEN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1516
Mailing Address - Country:US
Mailing Address - Phone:919-825-5797
Mailing Address - Fax:
Practice Address - Street 1:2415 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9691
Practice Address - Country:US
Practice Address - Phone:828-394-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30688101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)