Provider Demographics
NPI:1144921529
Name:CAROTHERS, SANDRA C (MA, LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 W DESERT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2932
Mailing Address - Country:US
Mailing Address - Phone:623-256-0021
Mailing Address - Fax:
Practice Address - Street 1:13832 N 32ND ST STE 136C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5643
Practice Address - Country:US
Practice Address - Phone:623-256-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty