Provider Demographics
NPI:1982122735
Name:FRALEY, SARA ELIZABETH (CDCA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:FRALEY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9210
Mailing Address - Country:US
Mailing Address - Phone:740-414-0336
Mailing Address - Fax:
Practice Address - Street 1:17 PRIVATE DRIVE 2089
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7388
Practice Address - Country:US
Practice Address - Phone:740-532-3767
Practice Address - Fax:740-532-3385
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162238101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)