Provider Demographics
NPI:1740503267
Name:SANTA CLARA, SABRINA S (LCPC, LPC, R-DMT)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:S
Last Name:SANTA CLARA
Suffix:
Gender:F
Credentials:LCPC, LPC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 N GREEN VALLEY PKWY # 503
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2120
Mailing Address - Country:US
Mailing Address - Phone:951-378-5868
Mailing Address - Fax:702-456-0455
Practice Address - Street 1:4252 VADER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2138
Practice Address - Country:US
Practice Address - Phone:951-378-5868
Practice Address - Fax:702-456-0492
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health