Provider Demographics
NPI:1790077451
Name:BOJORQUEZ, SARA HEATWOLE (LPCC-S)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HEATWOLE
Last Name:BOJORQUEZ
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:GORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25925 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-9810
Mailing Address - Country:US
Mailing Address - Phone:540-383-1047
Mailing Address - Fax:
Practice Address - Street 1:22251 STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-9452
Practice Address - Country:US
Practice Address - Phone:419-445-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1600088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE1600088OtherSTATE OF OHIO COUNSELOR, SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST BOARD