Provider Demographics
NPI:1710243910
Name:GANT, SANDRA (MHPP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GANT
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2831
Mailing Address - Country:US
Mailing Address - Phone:501-955-2674
Mailing Address - Fax:501-955-2654
Practice Address - Street 1:1901 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2831
Practice Address - Country:US
Practice Address - Phone:501-955-2674
Practice Address - Fax:501-955-2654
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator