Provider Demographics
NPI:1558808154
Name:COLLINSWORTH, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:COLLINSWORTH
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 1:2624 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2620
Mailing Address - Country:US
Mailing Address - Phone:937-328-5300
Mailing Address - Fax:937-322-4900
Practice Address - Street 1:2624 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2620
Practice Address - Country:US
Practice Address - Phone:937-328-5300
Practice Address - Fax:937-322-4900
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.131087-CS101YA0400X
OHC.1700474101YP2500X
OHE.2001748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)