Provider Demographics
NPI:1538434725
Name:MOXLEY, SARAH (MS/EDS, LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:MS/EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 RICHS RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27011-9055
Mailing Address - Country:US
Mailing Address - Phone:336-244-4107
Mailing Address - Fax:
Practice Address - Street 1:1386 WESTGATE CENTER DR
Practice Address - Street 2:STE. G
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3103
Practice Address - Country:US
Practice Address - Phone:336-244-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor