Provider Demographics
NPI:1134325269
Name:ZERVOUDAKIS, SANDRA MILENA (LMHC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MILENA
Last Name:ZERVOUDAKIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4363 NW 44TH TER
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4733
Mailing Address - Country:US
Mailing Address - Phone:954-254-6773
Mailing Address - Fax:
Practice Address - Street 1:2421 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6605
Practice Address - Country:US
Practice Address - Phone:954-923-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health