Provider Demographics
NPI:1184792384
Name:SADLER, TESSIE SMITH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TESSIE
Middle Name:SMITH
Last Name:SADLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0488
Mailing Address - Country:US
Mailing Address - Phone:434-738-0154
Mailing Address - Fax:434-738-9545
Practice Address - Street 1:523 MADISON STREET
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917
Practice Address - Country:US
Practice Address - Phone:434-738-0154
Practice Address - Fax:434-738-9545
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040060711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical