Provider Demographics
NPI:1851675094
Name:DELAND, SARAH LYNNE (LMSW, BCBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNNE
Last Name:DELAND
Suffix:
Gender:F
Credentials:LMSW, BCBA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNNE
Other - Last Name:BRETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, BCBA
Mailing Address - Street 1:2013 PARMENTER BLVD
Mailing Address - Street 2:APT. 215
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:248-837-2067
Practice Address - Street 1:4410 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6515
Practice Address - Country:US
Practice Address - Phone:248-837-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-14-16842103K00000X
MI68010893041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst