Provider Demographics
NPI:1891913844
Name:SEARS, VIVIAN G (BSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:G
Last Name:SEARS
Suffix:
Gender:F
Credentials:BSW, CADC
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:G
Other - Last Name:HENSON-SEARS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC, BSW
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-0568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1203 AMERICAN GREETING RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4811
Practice Address - Country:US
Practice Address - Phone:606-528-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0240101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker