Provider Demographics
NPI:1487145108
Name:FAWKES, SARA JEANNE (MA, LPPC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEANNE
Last Name:FAWKES
Suffix:
Gender:F
Credentials:MA, LPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 SAN SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2158
Mailing Address - Country:US
Mailing Address - Phone:925-286-1304
Mailing Address - Fax:
Practice Address - Street 1:963 SAN SIMEON DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2158
Practice Address - Country:US
Practice Address - Phone:925-286-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC4603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional