Healthcare Provider Details

I. General information

NPI: 1326315326
Provider Name (Legal Business Name): SADIE THE COACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N MAIN ST
ADRIAN MI
49221-2745
US

IV. Provider business mailing address

1416 S MAIN ST STE 220
ADRIAN MI
49221-4349
US

V. Phone/Fax

Practice location:
  • Phone: 517-438-0045
  • Fax: 517-265-2938
Mailing address:
  • Phone: 517-438-0045
  • Fax: 517-265-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008814
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SADIE CARRICO
Title or Position: PROFESSIONAL COUNSELOR & LIFE COACH
Credential: M.A. L.P.C.
Phone: 517-438-0045