Provider Demographics
NPI:1639237514
Name:POWELL, SARA J (LMSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:POWELL
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 1:42469 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1651
Mailing Address - Country:US
Mailing Address - Phone:586-239-8985
Mailing Address - Fax:586-477-4781
Practice Address - Street 1:42469 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1651
Practice Address - Country:US
Practice Address - Phone:586-239-8985
Practice Address - Fax:586-477-4781
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010881701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL950743OtherDEPT OF COMMUNITY HEALTH