Provider Demographics
NPI:1962493973
Name:JOHN, SANDRA LEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEE
Last Name:JOHN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2701
Mailing Address - Country:US
Mailing Address - Phone:570-735-3474
Mailing Address - Fax:
Practice Address - Street 1:1258 PURDYTOWN TPKE
Practice Address - Street 2:ROUTE 590 EAST
Practice Address - City:LAKEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18438-6793
Practice Address - Country:US
Practice Address - Phone:570-226-1963
Practice Address - Fax:570-226-1967
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional