Provider Demographics
NPI:1144592668
Name:SANDRA TOLLIVER LCSW CONSULTING & COUNSELLING
Entity Type:Organization
Organization Name:SANDRA TOLLIVER LCSW CONSULTING & COUNSELLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-732-9588
Mailing Address - Street 1:140 JEB STUART RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-0683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1079 SPRUCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4527
Practice Address - Country:US
Practice Address - Phone:276-732-9588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040008581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty