Provider Demographics
NPI:1134455512
Name:HERNDON, SARAH J (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:HERNDON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:5819 WINDING LN STE 105
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4067
Mailing Address - Country:US
Mailing Address - Phone:423-402-0126
Mailing Address - Fax:866-858-7831
Practice Address - Street 1:5819 WINDING LN STE 105
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4067
Practice Address - Country:US
Practice Address - Phone:423-402-0126
Practice Address - Fax:866-858-7831
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520383Medicaid