Healthcare Provider Details

I. General information

NPI: 1992841910
Provider Name (Legal Business Name): SARAH M HALVORSEN CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WA SEH ST
SAINT IGNACE MI
49781-9490
US

IV. Provider business mailing address

225 WA SEH ST
SAINT IGNACE MI
49781-9490
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-8689
  • Fax: 906-643-6716
Mailing address:
  • Phone: 906-643-8689
  • Fax: 906-643-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6801014327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: