Provider Demographics
NPI:1366008112
Name:SARA A. VAN TONGEREN, LMSW LLC
Entity Type:Organization
Organization Name:SARA A. VAN TONGEREN, LMSW LLC
Other - Org Name:THE FLOURISHING COLLECTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VAN TONGEREN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW
Authorized Official - Phone:904-535-6206
Mailing Address - Street 1:430 E 8TH ST STE 246
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3751
Mailing Address - Country:US
Mailing Address - Phone:616-827-7807
Mailing Address - Fax:616-828-0293
Practice Address - Street 1:27 W 25TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4910
Practice Address - Country:US
Practice Address - Phone:616-827-7807
Practice Address - Fax:616-828-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty