Provider Demographics
NPI:1477850154
Name:SANDS, CHRISTA (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:SANDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 WAYZATA BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1344
Mailing Address - Country:US
Mailing Address - Phone:763-566-0078
Mailing Address - Fax:
Practice Address - Street 1:8340 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9578
Practice Address - Country:US
Practice Address - Phone:763-566-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist