Provider Demographics
NPI:1578332979
Name:PENDERGRASS, SARAH LARRAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LARRAINE
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W PARK LOOP NW STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1759
Mailing Address - Country:US
Mailing Address - Phone:256-239-5662
Mailing Address - Fax:256-217-4162
Practice Address - Street 1:150 W PARK LOOP NW STE 101
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-1759
Practice Address - Country:US
Practice Address - Phone:256-239-5662
Practice Address - Fax:256-217-4162
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6502G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker