Provider Demographics
NPI:1851419873
Name:MARTIN, SARA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 BLISSWOOD ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1756
Mailing Address - Country:US
Mailing Address - Phone:870-926-9652
Mailing Address - Fax:
Practice Address - Street 1:206 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1363
Practice Address - Country:US
Practice Address - Phone:870-926-9652
Practice Address - Fax:870-609-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2021-04-28
Deactivation Date:2021-02-01
Deactivation Code:
Reactivation Date:2021-04-23
Provider Licenses
StateLicense IDTaxonomies
AR4825-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical