Provider Demographics
NPI:1982333415
Name:SHORES, SARA DAWN (LCMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DAWN
Last Name:SHORES
Suffix:
Gender:F
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 OLD MACCUMBER STATION RD APT 113
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-8525
Mailing Address - Country:US
Mailing Address - Phone:276-365-5010
Mailing Address - Fax:
Practice Address - Street 1:1430 COMMONWEALTH DR STE 300
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0365
Practice Address - Country:US
Practice Address - Phone:910-240-3392
Practice Address - Fax:910-447-4421
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health