Provider Demographics
NPI:1396180303
Name:ABRAHAM, SANDRA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 HIGHWAY 10 EAST
Mailing Address - Street 2:SUITE B
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-8306
Mailing Address - Country:US
Mailing Address - Phone:715-345-9690
Mailing Address - Fax:
Practice Address - Street 1:5541 US HIGHWAY 10 E
Practice Address - Street 2:SUITE B
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8306
Practice Address - Country:US
Practice Address - Phone:715-345-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1944-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health