Provider Demographics
NPI:1801308424
Name:ELLEN, SARAH ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:ELLEN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CEDARDEEN CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8037
Mailing Address - Country:US
Mailing Address - Phone:910-209-3732
Mailing Address - Fax:
Practice Address - Street 1:411 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-3428
Practice Address - Country:US
Practice Address - Phone:240-921-8566
Practice Address - Fax:240-623-9818
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional