Provider Demographics
NPI:1689050429
Name:COULON, SANDRA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:COULON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 WASHINGTON ST
Mailing Address - Street 2:STE. 900
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3221
Mailing Address - Country:US
Mailing Address - Phone:225-938-6624
Mailing Address - Fax:
Practice Address - Street 1:1233 WASHINGTON ST
Practice Address - Street 2:STE. 900
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3221
Practice Address - Country:US
Practice Address - Phone:225-938-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIN PROCESS103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical