Provider Demographics
NPI:1851453781
Name:ROSS, SANDRA KAY (MRC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:ROSS
Suffix:
Gender:F
Credentials:MRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19135
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-9135
Mailing Address - Country:US
Mailing Address - Phone:870-972-8883
Mailing Address - Fax:
Practice Address - Street 1:2913 KING ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5322
Practice Address - Country:US
Practice Address - Phone:870-972-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0107027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional