Provider Demographics
NPI:1881638351
Name:WILSON, SARAH M (LMFT, MA, LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT, MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392552
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9552
Mailing Address - Country:US
Mailing Address - Phone:512-575-8028
Mailing Address - Fax:
Practice Address - Street 1:3512 STELLHORN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815
Practice Address - Country:US
Practice Address - Phone:512-575-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002605A1041C0700X
IN35000703A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical