Provider Demographics
NPI:1831739275
Name:CHIOMA, SAGE (MPH, CSAC, CSAPC)
Entity type:Individual
Prefix:MS
First Name:SAGE
Middle Name:
Last Name:CHIOMA
Suffix:
Gender:F
Credentials:MPH, CSAC, CSAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-6803
Mailing Address - Country:US
Mailing Address - Phone:336-882-2125
Mailing Address - Fax:336-882-8153
Practice Address - Street 1:1101 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1318
Practice Address - Country:US
Practice Address - Phone:336-333-6860
Practice Address - Fax:336-275-1187
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-1982101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)