Provider Demographics
NPI:1003944869
Name:CHAVES DALTON, SANDRA (LPC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:CHAVES DALTON
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 1:136 KINGSLAND RD STE 1034
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1915
Mailing Address - Country:US
Mailing Address - Phone:973-797-9707
Mailing Address - Fax:
Practice Address - Street 1:136 KINGSLAND RD STE 1034
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1915
Practice Address - Country:US
Practice Address - Phone:973-797-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00406300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional