Provider Demographics
NPI:1851690226
Name:EKEINDE, SANDRA DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:DENISE
Last Name:EKEINDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DENISE
Other - Last Name:EKEINDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:349 E THOMAS RD
Mailing Address - Street 2:#E308
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3209
Mailing Address - Country:US
Mailing Address - Phone:480-238-0990
Mailing Address - Fax:
Practice Address - Street 1:4350 E CAMELBACK RD
Practice Address - Street 2:SUITE B210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2701
Practice Address - Country:US
Practice Address - Phone:602-343-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4085103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling