Provider Demographics
NPI:1346569894
Name:ROSS, SARAH LYNETTE (PHD, LPC, CAADC)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LYNETTE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD, LPC, CAADC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNETTE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPC, CAADC
Mailing Address - Street 1:6548 TOWN CENTER DR STE D
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4823
Mailing Address - Country:US
Mailing Address - Phone:800-693-1916
Mailing Address - Fax:
Practice Address - Street 1:6548 TOWN CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4823
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2482392101YM0800X
MI6401011852101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health