Provider Demographics
NPI:1619289444
Name:FOURNIER, SANDRA L (MA LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FOX RIDGE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2701
Mailing Address - Country:US
Mailing Address - Phone:386-846-6149
Mailing Address - Fax:
Practice Address - Street 1:75 FOX RIDGE CT
Practice Address - Street 2:SUITE C
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2701
Practice Address - Country:US
Practice Address - Phone:386-846-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist