Provider Demographics
NPI:1801575600
Name:CLANTON, SARAH MORRIS (RIC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MORRIS
Last Name:CLANTON
Suffix:
Gender:F
Credentials:RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13004 QUANDER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4539
Mailing Address - Country:US
Mailing Address - Phone:504-722-8179
Mailing Address - Fax:
Practice Address - Street 1:3330 BOURBON ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7333
Practice Address - Country:US
Practice Address - Phone:703-646-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health