Provider Demographics
NPI:1942517958
Name:SANDRA L BLANTON LMHC
Entity Type:Organization
Organization Name:SANDRA L BLANTON LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-762-9952
Mailing Address - Street 1:14080 SE 27TH CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-2806
Mailing Address - Country:US
Mailing Address - Phone:561-762-9952
Mailing Address - Fax:
Practice Address - Street 1:14080 SE 27TH CT
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-2806
Practice Address - Country:US
Practice Address - Phone:561-762-9952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8524251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health