Provider Demographics
NPI:1326544032
Name:BOOKER, SARAH (LSW, LCDCII)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BOOKER
Suffix:
Gender:F
Credentials:LSW, LCDCII
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:HUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 ELMWOOD PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-5402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 ELMWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-5402
Practice Address - Country:US
Practice Address - Phone:937-384-0580
Practice Address - Fax:937-384-0581
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161473101YA0400X
101YA0400X
OHS.2207833104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0289037Medicaid