Provider Demographics
NPI:1750715447
Name:EWING, SANDRA ROBERTA (CAC III)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ROBERTA
Last Name:EWING
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7290 SAMUEL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2796
Mailing Address - Country:US
Mailing Address - Phone:303-487-7776
Mailing Address - Fax:303-487-7868
Practice Address - Street 1:7290 SAMUEL DR STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2796
Practice Address - Country:US
Practice Address - Phone:303-487-7776
Practice Address - Fax:303-487-7868
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)