Provider Demographics
NPI:1700911195
Name:PERKINS, SANDRA ELAINE (LCDC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 EMMETT F LOWRY EXPY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2628
Mailing Address - Country:US
Mailing Address - Phone:409-944-4440
Mailing Address - Fax:
Practice Address - Street 1:7510 FM 1765
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-944-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9834101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8600BHOtherBLUE CROSS BLUE SHIELD