Provider Demographics
NPI:1104846518
Name:DUIS, SANDRA SMALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SMALL
Last Name:DUIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 CROSSINGS CENTRE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551
Mailing Address - Country:US
Mailing Address - Phone:434-525-1907
Mailing Address - Fax:434-525-1908
Practice Address - Street 1:1563 CROSSINGS CENTRE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551
Practice Address - Country:US
Practice Address - Phone:434-525-1907
Practice Address - Fax:434-525-1908
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical