Provider Demographics
NPI:1124149448
Name:PACKER-ARMSTRONG, SANDRA ANNE (MS)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANNE
Last Name:PACKER-ARMSTRONG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3125 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2997
Mailing Address - Country:US
Mailing Address - Phone:269-488-5905
Mailing Address - Fax:269-488-4906
Practice Address - Street 1:3125 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2997
Practice Address - Country:US
Practice Address - Phone:269-488-5905
Practice Address - Fax:269-488-5906
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006778103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling