Provider Demographics
NPI:1053681643
Name:DEVISSER, SARAH MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:DEVISSER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:3351 EAGLE RUN DR NE
Mailing Address - Street 2:STE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16760 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8864
Practice Address - Country:US
Practice Address - Phone:616-365-8920
Practice Address - Fax:616-365-8971
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010914391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical