Provider Demographics
NPI:1265956874
Name:VILLEGAS, SARAH (LMSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MAPLETON LN
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7312
Mailing Address - Country:US
Mailing Address - Phone:843-437-6371
Mailing Address - Fax:843-437-6371
Practice Address - Street 1:505 MAPLETON LN
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7312
Practice Address - Country:US
Practice Address - Phone:843-437-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7150104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC$$$$$$$$$Medicaid