Provider Demographics
NPI:1316326408
Name:MCKILLOP, SARAH (MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MCKILLOP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 SOMERVILLE RD SE
Mailing Address - Street 2:1
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4305
Mailing Address - Country:US
Mailing Address - Phone:256-260-7361
Mailing Address - Fax:
Practice Address - Street 1:1316 SOMERVILLE RD SE
Practice Address - Street 2:1
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4305
Practice Address - Country:US
Practice Address - Phone:256-260-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000025Medicaid