Provider Demographics
NPI:1164882817
Name:GRESCHUK, SARA HELENE (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HELENE
Last Name:GRESCHUK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:HELENE
Other - Last Name:TISCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:635 S MAPLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3838
Mailing Address - Country:US
Mailing Address - Phone:734-845-9839
Mailing Address - Fax:833-633-6171
Practice Address - Street 1:635 S MAPLE RD STE 2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3838
Practice Address - Country:US
Practice Address - Phone:734-845-9839
Practice Address - Fax:833-633-6171
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010964051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801096405OtherSOCIAL WORK LICENSE #