Provider Demographics
NPI:1710233069
Name:ROSE, SARA ANN
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:REEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:19530 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5200
Mailing Address - Country:US
Mailing Address - Phone:240-686-0707
Mailing Address - Fax:
Practice Address - Street 1:19530 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5200
Practice Address - Country:US
Practice Address - Phone:240-686-0707
Practice Address - Fax:240-686-0711
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3290101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor