Provider Demographics
NPI:1518958198
Name:EAVES, SANDRA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:EAVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N WALNUT AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7924
Mailing Address - Country:US
Mailing Address - Phone:830-606-2673
Mailing Address - Fax:830-608-9694
Practice Address - Street 1:711 N WALNUT AVE
Practice Address - Street 2:SUITE E
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7924
Practice Address - Country:US
Practice Address - Phone:830-606-2673
Practice Address - Fax:830-608-9694
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S35PMedicare PIN