Provider Demographics
NPI:1336556570
Name:COLVIN, SARITA RENEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARITA
Middle Name:RENEE
Last Name:COLVIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 5TH AVE N STE 166
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-1924
Mailing Address - Country:US
Mailing Address - Phone:205-463-1943
Mailing Address - Fax:205-392-8447
Practice Address - Street 1:1601 5TH AVE N STE 166
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1924
Practice Address - Country:US
Practice Address - Phone:205-463-1943
Practice Address - Fax:205-392-8447
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027085104100000X
TNLSW00000080861041C0700X
SC148571041C0700X
AL4075C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker