Provider Demographics
NPI:1700945268
Name:NOLL, SARAH ANN (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:NOLL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:MOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:224 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-3362
Mailing Address - Country:US
Mailing Address - Phone:843-543-3441
Mailing Address - Fax:
Practice Address - Street 1:3612 LANDMARK DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4039
Practice Address - Country:US
Practice Address - Phone:803-567-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC9100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health