Provider Demographics
NPI:1407393853
Name:TIDWELL, SARAH ELISE (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISE
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 GREEN SPRINGS HWY STE 161-367
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4935
Mailing Address - Country:US
Mailing Address - Phone:205-202-1883
Mailing Address - Fax:
Practice Address - Street 1:429 GREEN SPRINGS HWY STE 161-367
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4935
Practice Address - Country:US
Practice Address - Phone:205-202-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AL4023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health