Provider Demographics
NPI:1508074550
Name:CLEMENTS, SANDRA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-213-2525
Mailing Address - Fax:540-213-2555
Practice Address - Street 1:79 N MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2344
Practice Address - Country:US
Practice Address - Phone:540-213-2525
Practice Address - Fax:540-213-2555
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO803343MOtherSENTARA
VA305005OtherANTHEM
VA004945166Medicaid