Provider Demographics
NPI:1093728578
Name:JOSEPH, SANDRA CAROL (LLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CAROL
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34556 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3225
Mailing Address - Country:US
Mailing Address - Phone:248-579-0856
Mailing Address - Fax:248-489-1940
Practice Address - Street 1:34556 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3225
Practice Address - Country:US
Practice Address - Phone:248-579-0856
Practice Address - Fax:248-489-1940
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical