Provider Demographics
NPI:1114067683
Name:CUOCO, SANDRA (LMFT,)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:CUOCO
Suffix:
Gender:F
Credentials:LMFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2623
Mailing Address - Country:US
Mailing Address - Phone:843-645-7700
Mailing Address - Fax:188-890-8733
Practice Address - Street 1:60 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-2623
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:188-890-8733
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CT000993106H00000X
SC4530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)