Provider Demographics
NPI:1558797092
Name:MINTER, SANDRA LORRAINE (LCSW, LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LORRAINE
Last Name:MINTER
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LORRAINE
Other - Last Name:LISENBY NORFLEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LISW-CP
Mailing Address - Street 1:109 BEE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-5703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:910-551-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105761041C0700X
NCC0082901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical