Provider Demographics
NPI:1699943100
Name:MCCONNELL, SARA C (LBSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 W 48 RD
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8990
Mailing Address - Country:US
Mailing Address - Phone:877-398-2013
Mailing Address - Fax:231-723-1735
Practice Address - Street 1:395 3RD ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1718
Practice Address - Country:US
Practice Address - Phone:877-398-2013
Practice Address - Fax:231-723-1735
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802071332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6802071332OtherSTATE OF MICHIGAN LICENSE