Provider Demographics
NPI:1366176364
Name:ETHRIDGE, SARAH M (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:ETHRIDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BRITISH WOODS DR # 102A
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8242
Mailing Address - Country:US
Mailing Address - Phone:540-268-3546
Mailing Address - Fax:833-548-0842
Practice Address - Street 1:40 BRITISH WOODS DR # 102A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-8242
Practice Address - Country:US
Practice Address - Phone:540-268-3546
Practice Address - Fax:833-548-0842
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA9060126901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health