Provider Demographics
NPI:1255773438
Name:PAGE, SARA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:MARIE
Last Name:PAGE
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 1:6111 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE F-103
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6049
Mailing Address - Country:US
Mailing Address - Phone:770-395-0059
Mailing Address - Fax:770-395-1243
Practice Address - Street 1:6111 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE F-103
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-6049
Practice Address - Country:US
Practice Address - Phone:770-395-0059
Practice Address - Fax:770-395-1243
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOOO368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health