Provider Demographics
NPI:1457426264
Name:OWENS, SANDRA J (LCSW,PIP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:OWENS
Suffix:
Gender:F
Credentials:LCSW,PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-5207
Mailing Address - Country:US
Mailing Address - Phone:256-312-5443
Mailing Address - Fax:256-835-7927
Practice Address - Street 1:18 W 11TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4585
Practice Address - Country:US
Practice Address - Phone:256-312-5443
Practice Address - Fax:256-835-7927
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1440C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11129OtherBC FEDERAL PROVIDER NUM
AL09908OtherBCBS PROVIDER NUMBER
AL11129OtherBC FEDERAL PROVIDER NUM
ALP40421Medicare UPIN