Provider Demographics
NPI:1629512355
Name:KOBSAR, SANDRA (LPC, RPT, NCC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KOBSAR
Suffix:
Gender:F
Credentials:LPC, RPT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 BROOKVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2856
Mailing Address - Country:US
Mailing Address - Phone:720-282-9689
Mailing Address - Fax:
Practice Address - Street 1:5415 SUGARLOAF PKWY STE 2203
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7832
Practice Address - Country:US
Practice Address - Phone:720-282-9689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional