Sage Substance Abuse Guidance and Education

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

3099 Issued in TX

Legal business name

SAGE SUBSTANCE ABUSE GUIDANCE AND EDUCATION

Practice address

8401 Jacksboro Hwy
Lakeside, TX 76135-4351

Phone

(817) 238-9911

Fax

(817) 237-5711

NPI assigned

Jul 20, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dana L Hollingsworth, LCDC

Title

Executive Director

Phone

(817) 238-9911

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311120000000",
    "number": "1881982155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 JACKSBORO HWY",
            "city": "LAKESIDE",
            "state": "TX",
            "postal_code": "761354351",
            "telephone_number": "817-238-9911",
            "fax_number": "817-237-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 JACKSBORO HWY",
            "city": "LAKESIDE",
            "state": "TX",
            "postal_code": "761354351",
            "telephone_number": "817-238-9911",
            "fax_number": "817-237-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGE SUBSTANCE ABUSE GUIDANCE AND EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-20",
        "last_updated": "2011-07-20",
        "status": "A",
        "authorized_official_last_name": "HOLLINGSWORTH",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "817-238-9911",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCDC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "TX",
            "license": "3099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberli Paige Edmonson, SLP-ASSISTANT
• Noble U. Ezukanma, M.D.
• Mainstream Habilitation Services of Texas, Inc.
• Chase C McKinney, LPC
• Pathfinder Counseling and Consulting
• Kelle Creecy White, LCSW-S

• All providers in Lakeside, TX
• Mental Health Clinic/Center (Including Community Mental Health Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.