Provider Demographics
NPI:1568200418
Name:KONVICKA, SARA DARLENE (LCSW-S)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DARLENE
Last Name:KONVICKA
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-4703
Mailing Address - Country:US
Mailing Address - Phone:361-772-8462
Mailing Address - Fax:
Practice Address - Street 1:1004 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-4703
Practice Address - Country:US
Practice Address - Phone:361-772-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX575711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical