Provider Demographics
NPI:1083157697
Name:LETHERLAND, SANDRA (MS)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:LETHERLAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:PENNDEL
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5707
Mailing Address - Country:US
Mailing Address - Phone:215-752-1541
Mailing Address - Fax:
Practice Address - Street 1:1050 N HANCOCK ST
Practice Address - Street 2:APT 402
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2342
Practice Address - Country:US
Practice Address - Phone:215-275-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health