Provider Demographics
NPI:1720267529
Name:ANGOTTI, SARAH B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:B
Last Name:ANGOTTI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 5TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3094
Mailing Address - Country:US
Mailing Address - Phone:704-334-9955
Mailing Address - Fax:
Practice Address - Street 1:601 E 5TH ST STE 330
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3094
Practice Address - Country:US
Practice Address - Phone:704-334-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC00020991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC0002099OtherNC SOCIAL WORK LICENSING
NC6005709Medicaid