Provider Demographics
NPI:1154767937
Name:DAVIS, SARA RYAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:RYAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:RYAN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:286 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1943
Mailing Address - Country:US
Mailing Address - Phone:404-431-1380
Mailing Address - Fax:
Practice Address - Street 1:286 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1943
Practice Address - Country:US
Practice Address - Phone:404-431-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
GACSW0045651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical