Provider Demographics
NPI:1639887425
Name:GOLLING, SANDRA (LMFTA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GOLLING
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9634 191ST STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6308
Mailing Address - Country:US
Mailing Address - Phone:253-312-1896
Mailing Address - Fax:
Practice Address - Street 1:9125 BRIDGEPORT WAY SW STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2448
Practice Address - Country:US
Practice Address - Phone:253-312-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61365540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist