Provider Demographics
NPI:1295905495
Name:WHITLOCK, SANDRA LYNNE (MFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNNE
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNNE
Other - Last Name:GLEESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:206 SACRAMENTO ST STE 211
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2633
Mailing Address - Country:US
Mailing Address - Phone:530-559-2644
Mailing Address - Fax:
Practice Address - Street 1:206 SACRAMENTO ST STE 211
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2633
Practice Address - Country:US
Practice Address - Phone:530-559-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist