Provider Demographics
NPI:1205331337
Name:ANDERSON, SARA RUTH (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RUTH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E UNAKA AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4624
Mailing Address - Country:US
Mailing Address - Phone:865-281-1408
Mailing Address - Fax:865-244-3579
Practice Address - Street 1:114 E UNAKA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4624
Practice Address - Country:US
Practice Address - Phone:865-281-1408
Practice Address - Fax:865-244-3579
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TN4435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor