Provider Demographics
NPI:1881638807
Name:HALL, SANDRA SWARY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SWARY
Last Name:HALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10825 SEMINOLE BLVD
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3315
Mailing Address - Country:US
Mailing Address - Phone:727-623-0974
Mailing Address - Fax:727-623-0975
Practice Address - Street 1:10825 SEMINOLE BLVD
Practice Address - Street 2:UNIT 2A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3315
Practice Address - Country:US
Practice Address - Phone:727-623-0974
Practice Address - Fax:727-623-0975
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767696400Medicaid