Provider Demographics
NPI:1437462512
Name:SHOOK-ROSEN, SARA ANN (LCMHCA, LCAS, CCS)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:SHOOK-ROSEN
Suffix:
Gender:F
Credentials:LCMHCA, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E SIX FORKS RD STE 117
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7753
Mailing Address - Country:US
Mailing Address - Phone:919-833-8899
Mailing Address - Fax:919-833-8894
Practice Address - Street 1:128 QUADE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-7400
Practice Address - Country:US
Practice Address - Phone:919-833-8899
Practice Address - Fax:919-833-8894
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1566101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)