Provider Demographics
NPI:1376959122
Name:SANSON, MARIA (MS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SANSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 RICHMOND RD APT 137
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2174
Mailing Address - Country:US
Mailing Address - Phone:903-949-9962
Mailing Address - Fax:
Practice Address - Street 1:4613 PARKWAY DR STE 6
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1142
Practice Address - Country:US
Practice Address - Phone:903-949-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200111200AMedicaid