Healthcare Provider Details

I. General information

NPI: 1780161885
Provider Name (Legal Business Name): SARAH CISSELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E LIBERTY ST STE 203
ANN ARBOR MI
48104-2136
US

IV. Provider business mailing address

103 E LIBERTY ST STE 203
ANN ARBOR MI
48104-2136
US

V. Phone/Fax

Practice location:
  • Phone: 734-325-4083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801107931
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: