Provider Demographics
NPI:1457131062
Name:CARICO, SARA JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:CARICO
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 1:1125 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2426
Mailing Address - Country:US
Mailing Address - Phone:423-367-2412
Mailing Address - Fax:
Practice Address - Street 1:2204 PAVILION DR STE 107
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4651
Practice Address - Country:US
Practice Address - Phone:423-343-1442
Practice Address - Fax:423-343-1445
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical