Provider Demographics
NPI:1811936966
Name:MOORE, SARAH MORRIS (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MORRIS
Last Name:MOORE
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 1:2580 POTTERS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4324
Mailing Address - Country:US
Mailing Address - Phone:757-498-9391
Mailing Address - Fax:757-498-7073
Practice Address - Street 1:2580 POTTERS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4324
Practice Address - Country:US
Practice Address - Phone:757-498-9391
Practice Address - Fax:757-498-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040000531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003105011OtherMAGELLAN
VA008900388Medicaid
VAO87285OtherSENTARA/OPTIMA
VA331593OtherANTHEM BCBS OF VA
VA331593OtherANTHEM BCBS OF VA