Provider Demographics
NPI:1033428321
Name:KERAI, SARA MOORE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MOORE
Last Name:KERAI
Suffix:
Gender:F
Credentials:LPC
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 140074
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49514-0074
Mailing Address - Country:US
Mailing Address - Phone:202-306-0448
Mailing Address - Fax:
Practice Address - Street 1:1568 MOUNT MERCY DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4905
Practice Address - Country:US
Practice Address - Phone:202-306-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019434101YP2500X
VA0701009098101YP2500X
MDLC10855101YP2500X
DCPRC13868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional