Provider Demographics
NPI:1578538187
Name:SAGE, ELIZABETH ANNA (LICSW,MAC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNA
Last Name:SAGE
Suffix:
Gender:F
Credentials:LICSW,MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 IRELAND AVE
Mailing Address - Street 2:IRELAND ARMYCOMMUNITY HOSPITAL
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5111
Mailing Address - Country:US
Mailing Address - Phone:502-624-9007
Mailing Address - Fax:502-624-9549
Practice Address - Street 1:289 IRELAND AVE
Practice Address - Street 2:IRELAND ARMYCOMMUNITY HOSPITAL
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5111
Practice Address - Country:US
Practice Address - Phone:502-624-9007
Practice Address - Fax:502-624-9549
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNBAECERTIFICATE24589101YA0400X
WALW000067231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCERTIFICATE 24589OtherMASTER ADDICTION COUNSELO
WALW00006723OtherSICAL WORK LICENSE