Provider Demographics
NPI:1871041483
Name:BARRERA, SANDRA SOFIA (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:SOFIA
Last Name:BARRERA
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 PROVIDENCE LN
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3226
Mailing Address - Country:US
Mailing Address - Phone:336-896-1323
Mailing Address - Fax:336-896-1327
Practice Address - Street 1:4401 PROVIDENCE LN
Practice Address - Street 2:SUITE 121
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3226
Practice Address - Country:US
Practice Address - Phone:336-896-1323
Practice Address - Fax:336-896-1327
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0107881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical