Provider Demographics
NPI:1386064152
Name:MEDINA, SARA EVANGELINA (LCSW, LCDC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:EVANGELINA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:EVANGELINA
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9122 SMOKEHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4800
Mailing Address - Country:US
Mailing Address - Phone:832-462-0249
Mailing Address - Fax:
Practice Address - Street 1:9122 SMOKEHOLLOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4800
Practice Address - Country:US
Practice Address - Phone:832-462-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical