Provider Demographics
NPI:1972742625
Name:MAXEY, SANDRA (MA, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:MAXEY
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1925
Mailing Address - Country:US
Mailing Address - Phone:304-347-9818
Mailing Address - Fax:304-347-9822
Practice Address - Street 1:200 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1925
Practice Address - Country:US
Practice Address - Phone:304-347-9818
Practice Address - Fax:304-347-9822
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00812168104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker