Provider Demographics
NPI:1689939589
Name:SANDE, ELLEN ANDREA (LPCC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ANDREA
Last Name:SANDE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:ANDREA
Other - Last Name:SANDE-KERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4966 EL CAMINO REAL
Mailing Address - Street 2:SUITE 119
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1436
Mailing Address - Country:US
Mailing Address - Phone:408-510-6429
Mailing Address - Fax:
Practice Address - Street 1:4966 EL CAMINO REAL
Practice Address - Street 2:SUITE 119
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1436
Practice Address - Country:US
Practice Address - Phone:408-510-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 34101YP2500X
NJ37PC00313100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional