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NPI Code Detail

MEDICARE: SARAH COLLINSWORTH

MEDICARE: SARAH COLLINSWORTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.131087-CSOH
2101YP2500XProfessional CounselorC.1700474OH
3101YP2500XProfessional CounselorE.2001748OH

General Provider Information

NPI Number : 1558808154
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH COLLINSWORTH
Provider Business Mailing Address
First Line : 2624 LEXINGTON AVE
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45505-2620
Country : US
Telephone Number : 937-328-5300
Fax Number : 937-322-4900
Provider Business Practice Location Address
First Line : 2624 LEXINGTON AVE
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45505-2620
Country : US
Telephone Number : 937-328-5300
Fax Number : 937-322-4900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2017
Last Update Date : 06/09/2020

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Directions to “ SARAH COLLINSWORTH ” Practice Location

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