Provider Demographics
NPI:1295737732
Name:DAVID, SALLY A (MA LMHC)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:A
Last Name:DAVID
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 OAK HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1811
Mailing Address - Country:US
Mailing Address - Phone:407-293-2943
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD
Practice Address - Street 2:STE 305
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2115
Practice Address - Country:US
Practice Address - Phone:407-975-0415
Practice Address - Fax:407-975-0417
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health