Provider Demographics
NPI:1942700190
Name:BOONE, SANDRA E (LPCC, LCADC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:BOONE
Suffix:
Gender:F
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 NOE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9570
Mailing Address - Country:US
Mailing Address - Phone:270-789-7883
Mailing Address - Fax:
Practice Address - Street 1:400 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8799
Practice Address - Country:US
Practice Address - Phone:270-900-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276893101YA0400X
KY246250101YM0800X
KY278254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health