Provider Demographics
NPI:1497568927
Name:PRIVETT, SABRINA MARIE (BA)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:MARIE
Last Name:PRIVETT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 HUDGINS ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3535
Mailing Address - Country:US
Mailing Address - Phone:304-752-7830
Mailing Address - Fax:304-752-7832
Practice Address - Street 1:313 HUDGINS ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3535
Practice Address - Country:US
Practice Address - Phone:304-784-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker