Provider Demographics
NPI:1881386167
Name:KAGIN, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KAGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:COVELO
Mailing Address - State:CA
Mailing Address - Zip Code:95428-0353
Mailing Address - Country:US
Mailing Address - Phone:707-234-0124
Mailing Address - Fax:
Practice Address - Street 1:40200 MENDOCINO PASS RD.
Practice Address - Street 2:
Practice Address - City:COVELO
Practice Address - State:CA
Practice Address - Zip Code:95428
Practice Address - Country:US
Practice Address - Phone:707-234-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist