Provider Demographics
NPI:1023081296
Name:OVERTON, SARITA R (PHD)
Entity type:Individual
Prefix:DR
First Name:SARITA
Middle Name:R
Last Name:OVERTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 W LAKE LANSING RD
Mailing Address - Street 2:SUITE # 500
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8465
Mailing Address - Country:US
Mailing Address - Phone:517-333-9494
Mailing Address - Fax:517-333-3311
Practice Address - Street 1:790 W LAKE LANSING RD
Practice Address - Street 2:SUITE # 500
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8465
Practice Address - Country:US
Practice Address - Phone:517-333-9494
Practice Address - Fax:517-333-3311
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006941103TC1900X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C34668Medicare ID - Type UnspecifiedPSYCHOLOGIST