Provider Demographics
NPI:1407489321
Name:SANDS, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SANDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 OLD VINES TRL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3412
Mailing Address - Country:US
Mailing Address - Phone:317-494-8583
Mailing Address - Fax:
Practice Address - Street 1:1217 OLD VINES TRL
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3412
Practice Address - Country:US
Practice Address - Phone:317-494-8583
Practice Address - Fax:317-497-0254
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2022-01-28
Deactivation Date:2020-10-30
Deactivation Code:
Reactivation Date:2021-11-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician