Provider Demographics
NPI:1417144452
Name:SAGE, SANDI LEA (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:SANDI
Middle Name:LEA
Last Name:SAGE
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10752 DEERWOOD PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4849
Mailing Address - Country:US
Mailing Address - Phone:904-394-2903
Mailing Address - Fax:904-394-2904
Practice Address - Street 1:10752 DEERWOOD PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4849
Practice Address - Country:US
Practice Address - Phone:904-394-2903
Practice Address - Fax:904-394-2904
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5353101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0439OtherBCBS FL