Provider Demographics
NPI:1134566763
Name:WEBB, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 W CENTRE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-6314
Mailing Address - Country:US
Mailing Address - Phone:269-270-9184
Mailing Address - Fax:
Practice Address - Street 1:1591 W CENTRE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6314
Practice Address - Country:US
Practice Address - Phone:269-270-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor