Provider Demographics
NPI:1326035742
Name:HARRISON-MILLS, SARA (LISW-S)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HARRISON-MILLS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-0172
Mailing Address - Country:US
Mailing Address - Phone:614-450-0127
Mailing Address - Fax:866-312-6831
Practice Address - Street 1:3962 N HAMPTON DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8430
Practice Address - Country:US
Practice Address - Phone:614-450-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10001888.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341719Medicaid
OHH03635OtherMEDICARE PTAN