Provider Demographics
NPI:1073639134
Name:GARBUZINSKI, SANDRA L (LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:GARBUZINSKI
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:55 NORMACAROL RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-3338
Mailing Address - Country:US
Mailing Address - Phone:901-606-6098
Mailing Address - Fax:
Practice Address - Street 1:8130 COUNTRY VILLAGE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2087
Practice Address - Country:US
Practice Address - Phone:901-308-2915
Practice Address - Fax:901-308-2924
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC000000167 8101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPC0000001678OtherSTATE LICENSE