Provider Demographics
NPI:1871820399
Name:THONGKHAMSOUK, SANDY ANN (MSW)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:ANN
Last Name:THONGKHAMSOUK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 WESTFORD ST.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851
Mailing Address - Country:US
Mailing Address - Phone:415-286-3882
Mailing Address - Fax:
Practice Address - Street 1:391 VARNUM ST.
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-322-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor