Healthcare Provider Details

I. General information

NPI: 1346569894
Provider Name (Legal Business Name): SARAH LYNETTE ROSS PHD, LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH LYNETTE JACKSON PHD, LPC, CAADC

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346-4823
US

IV. Provider business mailing address

6548 TOWN CENTER DR STE D
CLARKSTON MI
48346-4823
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax: 248-605-3525
Mailing address:
  • Phone: 800-693-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL2482392
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401011852
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: