Provider Demographics
NPI:1265773535
Name:WILLIAMS, SARA A (CG60338965)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CG60338965
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3151
Mailing Address - Country:US
Mailing Address - Phone:360-713-4323
Mailing Address - Fax:360-750-1374
Practice Address - Street 1:1014 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3151
Practice Address - Country:US
Practice Address - Phone:360-713-4323
Practice Address - Fax:360-750-1374
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60338965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health