Provider Demographics
NPI:1063610236
Name:WILLERSON, SARA B (LCSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:B
Last Name:WILLERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140454
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-0454
Mailing Address - Country:US
Mailing Address - Phone:214-596-8300
Mailing Address - Fax:
Practice Address - Street 1:8057 SHADY OAK DR
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-8409
Practice Address - Country:US
Practice Address - Phone:214-596-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical