Basic Information
| Provider Information | |||||||||
| NPI: | 1396397014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAROTHERS | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LCSW, LCADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2645 LEITCHFIELD RD STE 104 | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427018306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702348180 | ||||||||
| FaxNumber: | 2702348179 | ||||||||
| Practice Location | |||||||||
| Address1: | 2645 LEITCHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427018306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702348180 | ||||||||
| FaxNumber: | 2702348179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2019 | ||||||||
| LastUpdateDate: | 09/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 168441 | KY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 168441 | KY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 5051 | KY | N | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | 5051 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.