Provider Demographics
NPI:1043630734
Name:THE SAGE CENTER FOR TRAUMA AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:THE SAGE CENTER FOR TRAUMA AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-681-3001
Mailing Address - Street 1:2725 CANTRELL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-2044
Mailing Address - Country:US
Mailing Address - Phone:501-400-8850
Mailing Address - Fax:501-400-8839
Practice Address - Street 1:2725 CANTRELL RD STE 105
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-2044
Practice Address - Country:US
Practice Address - Phone:501-400-8850
Practice Address - Fax:501-400-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11-25P103TC0700X
AR6256-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty