Provider Demographics
NPI:1821081084
Name:BILLINGS, SANDRA JOYCE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JOYCE
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 W LAKE DAMON DR
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-8954
Mailing Address - Country:US
Mailing Address - Phone:863-453-4161
Mailing Address - Fax:863-453-4161
Practice Address - Street 1:930 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-3312
Practice Address - Country:US
Practice Address - Phone:863-453-4161
Practice Address - Fax:863-453-4161
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3460Medicare ID - Type Unspecified