Provider Demographics
NPI:1689825911
Name:ANDERSON, SARA REBECCA (LMHC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:REBECCA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 STOCKTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4561
Mailing Address - Country:US
Mailing Address - Phone:904-945-5642
Mailing Address - Fax:888-826-7458
Practice Address - Street 1:1662 STOCKTON ST STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4561
Practice Address - Country:US
Practice Address - Phone:904-945-5642
Practice Address - Fax:888-826-7458
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7609101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor