Provider Demographics
NPI:1962149096
Name:PIECIAK, SARAH (TLLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PIECIAK
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 GRANGER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6905
Mailing Address - Country:US
Mailing Address - Phone:586-854-4696
Mailing Address - Fax:
Practice Address - Street 1:5777 W MAPLE RD STE 145
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4471
Practice Address - Country:US
Practice Address - Phone:248-455-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009524103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist