Provider Demographics
NPI:1396365722
Name:KOLOKOTSAS, SARA (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KOLOKOTSAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1350
Mailing Address - Country:US
Mailing Address - Phone:972-521-6105
Mailing Address - Fax:
Practice Address - Street 1:2102 DORSEY DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-0925
Practice Address - Country:US
Practice Address - Phone:469-249-3585
Practice Address - Fax:201-401-7843
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker