Provider Demographics
NPI:1780933416
Name:WATERS, SARA LOUISE (LICSW, CMHS)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:LOUISE
Last Name:WATERS
Suffix:
Gender:F
Credentials:LICSW, CMHS
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:LOUISE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17018 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5137
Mailing Address - Country:US
Mailing Address - Phone:206-321-2497
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:17018 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5137
Practice Address - Country:US
Practice Address - Phone:206-321-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60940310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker