Provider Demographics
NPI:1225668163
Name:ANICETO, SARA F (MS LPC SAC-IT NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:F
Last Name:ANICETO
Suffix:
Gender:F
Credentials:MS LPC SAC-IT NCC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:FAITH
Other - Last Name:WILBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 S MACY ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4241
Mailing Address - Country:US
Mailing Address - Phone:920-929-3917
Mailing Address - Fax:
Practice Address - Street 1:160 S MACY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4241
Practice Address - Country:US
Practice Address - Phone:920-929-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WI10122-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor