Provider Demographics
NPI:1609292465
Name:EWING, SARA M (PSYD, LPCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:EWING
Suffix:
Gender:F
Credentials:PSYD, LPCC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-1188
Mailing Address - Country:US
Mailing Address - Phone:218-749-2881
Mailing Address - Fax:218-749-3086
Practice Address - Street 1:624 13TH ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3149
Practice Address - Country:US
Practice Address - Phone:218-749-2881
Practice Address - Fax:218-749-3086
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health