Provider Demographics
NPI:1831573757
Name:BLACK, SARA (LPC, LCDC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12740 HILLCREST RD STE 224
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2168
Mailing Address - Country:US
Mailing Address - Phone:972-863-7133
Mailing Address - Fax:844-318-2942
Practice Address - Street 1:12740 HILLCREST RD STE 224
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2168
Practice Address - Country:US
Practice Address - Phone:972-863-7133
Practice Address - Fax:844-318-2942
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11507101YA0400X
TX68080101YP2500X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional