Provider Demographics
NPI:1245773845
Name:VIVENS, SARA (LPC)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:
Last Name:VIVENS
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 1:5205 N WAYNE AVE
Mailing Address - Street 2:APT 2M
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2242
Mailing Address - Country:US
Mailing Address - Phone:614-439-8983
Mailing Address - Fax:
Practice Address - Street 1:5205 N WAYNE AVE
Practice Address - Street 2:APT 2M
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2242
Practice Address - Country:US
Practice Address - Phone:614-439-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional