Provider Demographics
NPI:1700811551
Name:QUAIFE, SANDRA JEAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:QUAIFE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 VALPARAISO ST STE 209
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3137
Mailing Address - Country:US
Mailing Address - Phone:219-252-5464
Mailing Address - Fax:219-728-1860
Practice Address - Street 1:2005 VALPARAISO ST STE 209
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3137
Practice Address - Country:US
Practice Address - Phone:219-252-5464
Practice Address - Fax:219-728-1860
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001886A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPENDINGOtherNPI
AR5X790OtherBLUE CROSS