Provider Demographics
NPI:1952439721
Name:DERINGTON, SARA WALKER (LSPE)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:WALKER
Last Name:DERINGTON
Suffix:
Gender:F
Credentials:LSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2201
Mailing Address - Country:US
Mailing Address - Phone:931-461-1300
Mailing Address - Fax:931-461-1302
Practice Address - Street 1:1803 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2201
Practice Address - Country:US
Practice Address - Phone:931-461-1300
Practice Address - Fax:931-461-1302
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE1621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health