Provider Demographics
NPI:1770320996
Name:BUSSEY, SARAH (LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 EUCLID AVE APT 545
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6618
Mailing Address - Country:US
Mailing Address - Phone:617-901-6824
Mailing Address - Fax:
Practice Address - Street 1:1118 SAM NEWELL RD STE D
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5041
Practice Address - Country:US
Practice Address - Phone:617-901-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health