Provider Demographics
NPI:1477737252
Name:WILCOX, SANDRA FOSTER
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:FOSTER
Last Name:WILCOX
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 1:905 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6402
Mailing Address - Country:US
Mailing Address - Phone:505-437-8964
Mailing Address - Fax:
Practice Address - Street 1:905 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6402
Practice Address - Country:US
Practice Address - Phone:505-437-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0106871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health