Provider Demographics
NPI:1932573359
Name:FAGAN, SARAH DANIELLE CAMPAGNA (MA, NCC, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:DANIELLE CAMPAGNA
Last Name:FAGAN
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:DANIELLE
Other - Last Name:CAMPAGNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LCMHC
Mailing Address - Street 1:1862 ELLIOT FARM RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9739
Mailing Address - Country:US
Mailing Address - Phone:910-429-5050
Mailing Address - Fax:
Practice Address - Street 1:1862 ELLIOT FARM RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9739
Practice Address - Country:US
Practice Address - Phone:910-429-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11797101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor