Provider Demographics
NPI:1851593727
Name:CARO, SANDRA GAYLE (LCDC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:GAYLE
Last Name:CARO
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 PHILLIPS BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:ABERNATHY
Mailing Address - State:TX
Mailing Address - Zip Code:79311-2100
Mailing Address - Country:US
Mailing Address - Phone:806-298-2311
Mailing Address - Fax:806-765-0130
Practice Address - Street 1:1614 AVENUE K
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-5042
Practice Address - Country:US
Practice Address - Phone:806-763-7633
Practice Address - Fax:806-765-0130
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9949101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)