Provider Demographics
NPI:1770766347
Name:SELLERS, SARA DEGENOVA (MA LPC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:DEGENOVA
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MONTESANO PARK DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2475
Mailing Address - Country:US
Mailing Address - Phone:314-223-6340
Mailing Address - Fax:
Practice Address - Street 1:10820 SUNSET OFFICE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1016
Practice Address - Country:US
Practice Address - Phone:314-223-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024370101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor