Provider Demographics
NPI:1841173523
Name:WILSON, SARAH R (PHD, MA, APC)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:R
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD, MA, APC
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:R
Other - Last Name:WILSON-MONTEMAYOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MA, APC
Mailing Address - Street 1:SOUL WEAVING COUNSELING, LLC
Mailing Address - Street 2:5331 S MACADAM AVE, SUITE 258; PMB 420
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-573-5681
Mailing Address - Fax:
Practice Address - Street 1:5441 S MACADAM AVE STE R
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3822
Practice Address - Country:US
Practice Address - Phone:503-573-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR11134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional