Provider Demographics
NPI:1366697112
Name:KOUGH, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 EDEN WAY N STE E507
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2798
Mailing Address - Country:US
Mailing Address - Phone:757-609-2726
Mailing Address - Fax:757-609-2874
Practice Address - Street 1:1015 EDEN WAY N STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2787
Practice Address - Country:US
Practice Address - Phone:757-609-2726
Practice Address - Fax:757-609-2874
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional