Provider Demographics
NPI:1134392210
Name:DAVIS, SARAH EISNER (LISW-CP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:EISNER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LOVETT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6510
Mailing Address - Country:US
Mailing Address - Phone:864-234-1150
Mailing Address - Fax:864-234-1151
Practice Address - Street 1:111 LOVETT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6510
Practice Address - Country:US
Practice Address - Phone:864-234-1150
Practice Address - Fax:864-234-1151
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
SC97821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator