Provider Demographics
NPI:1548427727
Name:MCFALL, SANDRA KATHLEEN (MA, LAC, NCACII)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KATHLEEN
Last Name:MCFALL
Suffix:
Gender:F
Credentials:MA, LAC, NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E HARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9663
Mailing Address - Country:US
Mailing Address - Phone:970-263-7775
Mailing Address - Fax:970-241-9205
Practice Address - Street 1:704 E HARBOR CIR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9663
Practice Address - Country:US
Practice Address - Phone:970-263-7775
Practice Address - Fax:970-241-9205
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)