Provider Demographics
NPI:1851806137
Name:PERKS, SANDRA JUNE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JUNE
Last Name:PERKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 TEAL RD N
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-8215
Mailing Address - Country:US
Mailing Address - Phone:304-671-1746
Mailing Address - Fax:
Practice Address - Street 1:540 TEAL RD N
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-8215
Practice Address - Country:US
Practice Address - Phone:304-671-1746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009444741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical