Provider Demographics
NPI:1629136270
Name:MCCORMICK, SANDRA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, LP, NCC, LPC
Mailing Address - Street 1:455 E EISENHOWER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3324
Mailing Address - Country:US
Mailing Address - Phone:517-580-5727
Mailing Address - Fax:517-537-0060
Practice Address - Street 1:455 E EISENHOWER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3324
Practice Address - Country:US
Practice Address - Phone:517-580-5727
Practice Address - Fax:517-537-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007916101YP2500X
MI6301013720103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional