Provider Demographics
NPI:1275595928
Name:ALA, SANDRA LYNN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LYNN
Last Name:ALA
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 1:3757 SW KASIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3822
Mailing Address - Country:US
Mailing Address - Phone:786-202-2695
Mailing Address - Fax:
Practice Address - Street 1:18999 BISCAYNE BLVD
Practice Address - Street 2:200
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2814
Practice Address - Country:US
Practice Address - Phone:305-933-9820
Practice Address - Fax:305-933-9843
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health