Provider Demographics
NPI:1720239031
Name:PEREZ, SARA (CAC)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 CLAYSTONE ST SE STE 212
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5781
Mailing Address - Country:US
Mailing Address - Phone:616-954-1991
Mailing Address - Fax:616-233-0718
Practice Address - Street 1:3351 CLAYSTONE ST SE STE 212
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5781
Practice Address - Country:US
Practice Address - Phone:616-954-1991
Practice Address - Fax:616-233-0718
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381359253OtherTAX ID #