Provider Demographics
NPI:1922618628
Name:HEREK, SANDRA ANTONIA (LMFT-RESIDENT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANTONIA
Last Name:HEREK
Suffix:
Gender:F
Credentials:LMFT-RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-2031
Mailing Address - Country:US
Mailing Address - Phone:757-272-3415
Mailing Address - Fax:
Practice Address - Street 1:11923 CENTRE ST STE C
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1702
Practice Address - Country:US
Practice Address - Phone:757-272-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0730000578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist