Provider Demographics
NPI:1760901235
Name:SACK, LAUREN (LMSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SACK
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 1:12301 S LANGOUR LN APT 104
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8292
Mailing Address - Country:US
Mailing Address - Phone:616-773-9251
Mailing Address - Fax:
Practice Address - Street 1:170 COLLEGE AVE STE 300
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2982
Practice Address - Country:US
Practice Address - Phone:616-773-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical