Provider Demographics
NPI:1407252331
Name:BOONE, SANDY FRYE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:FRYE
Last Name:BOONE
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 1:955 E MAIN ST STE E PMB 61
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-4296
Mailing Address - Country:US
Mailing Address - Phone:803-760-7490
Mailing Address - Fax:844-712-9234
Practice Address - Street 1:1905 SUNSET BLVD STE C
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5955
Practice Address - Country:US
Practice Address - Phone:803-760-7490
Practice Address - Fax:844-712-9234
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor