Provider Demographics
NPI:1497307466
Name:HIOTT-MILLIS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HIOTT-MILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 UNIVERSITY AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3264
Mailing Address - Country:US
Mailing Address - Phone:510-841-1262
Mailing Address - Fax:
Practice Address - Street 1:1918 UNIVERSITY AVE STE 2B
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3264
Practice Address - Country:US
Practice Address - Phone:510-841-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2020-09-17
Deactivation Date:2020-07-27
Deactivation Code:
Reactivation Date:2020-09-09
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician