Provider Demographics
NPI:1750400313
Name:CARMICHAEL, SANDRA JENNIFER (LCSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JENNIFER
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:CARMICHAEL-CALVERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:105 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1922
Mailing Address - Country:US
Mailing Address - Phone:574-239-7021
Mailing Address - Fax:574-287-3116
Practice Address - Street 1:215 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2457
Practice Address - Country:US
Practice Address - Phone:219-921-0705
Practice Address - Fax:219-921-0557
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004838A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical