Provider Demographics
NPI:1801487145
Name:A NEW SHORE COUNSELING
Entity type:Organization
Organization Name:A NEW SHORE COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-694-0042
Mailing Address - Street 1:4211 POPLAR LEVEL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1527
Mailing Address - Country:US
Mailing Address - Phone:502-694-0042
Mailing Address - Fax:502-305-2123
Practice Address - Street 1:4211 POPLAR LEVEL RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1527
Practice Address - Country:US
Practice Address - Phone:502-694-0042
Practice Address - Fax:502-305-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty