Provider Demographics
NPI:1932705316
Name:ELIZABETTA, SARAH ROSE (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:ELIZABETTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MONARCHOS BND
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-2001
Mailing Address - Country:US
Mailing Address - Phone:615-961-3228
Mailing Address - Fax:
Practice Address - Street 1:100 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1941
Practice Address - Country:US
Practice Address - Phone:615-560-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC000000452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional