Provider Demographics
NPI:1194070243
Name:TELLA, SARA T (LMSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:T
Last Name:TELLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 26 MILE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3851
Mailing Address - Country:US
Mailing Address - Phone:586-467-5955
Mailing Address - Fax:586-207-2077
Practice Address - Street 1:6303 26 MILE RD STE 120
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48094-3851
Practice Address - Country:US
Practice Address - Phone:586-467-5955
Practice Address - Fax:586-207-2077
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094379104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker