Provider Demographics
NPI:1538335526
Name:PUWALOWSKI, SARAH (MA, LPA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:PUWALOWSKI
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 BURNT MILL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2654
Mailing Address - Country:US
Mailing Address - Phone:910-251-5817
Mailing Address - Fax:910-251-2652
Practice Address - Street 1:3311 BURNT MILL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2654
Practice Address - Country:US
Practice Address - Phone:910-251-5817
Practice Address - Fax:910-251-2652
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3534103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403402Medicaid