Provider Demographics
NPI:1912275884
Name:LARSON, SARA WHITNEY (LCAS-P)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:WHITNEY
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2993
Mailing Address - Country:US
Mailing Address - Phone:336-532-0500
Mailing Address - Fax:336-532-0509
Practice Address - Street 1:2140 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3004
Practice Address - Country:US
Practice Address - Phone:336-532-0500
Practice Address - Fax:336-532-0509
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)