Provider Demographics
NPI:1346855194
Name:SAGE LIFE COUNSELING
Entity Type:Organization
Organization Name:SAGE LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:256-617-3236
Mailing Address - Street 1:127 MILDRED WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4072
Mailing Address - Country:US
Mailing Address - Phone:256-617-3236
Mailing Address - Fax:
Practice Address - Street 1:7800 MADISON BLVD STE 705
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2049
Practice Address - Country:US
Practice Address - Phone:256-617-3236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)