Provider Demographics
NPI:1841392958
Name:POLLOCK, SANDRA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:POLLOCK
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 1:1540 LAKE BALDWIN LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6679
Mailing Address - Country:US
Mailing Address - Phone:407-894-6777
Mailing Address - Fax:
Practice Address - Street 1:1540 LAKE BALDWIN LN
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6679
Practice Address - Country:US
Practice Address - Phone:407-894-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0002250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN1276452OtherREGISTERED NURSE
FLMH0002250OtherMENTAL HEALTH COUNSELOR