Provider Demographics
NPI:1952874349
Name:WHITE SANDS COUNSELING CENTER
Entity Type:Organization
Organization Name:WHITE SANDS COUNSELING CENTER
Other - Org Name:WHITE SANDS COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-525-2551
Mailing Address - Street 1:9511 HOLSBERRY RD STE B1
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-1320
Mailing Address - Country:US
Mailing Address - Phone:850-525-2551
Mailing Address - Fax:
Practice Address - Street 1:9511 HOLSBERRY RD STE B1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1320
Practice Address - Country:US
Practice Address - Phone:850-525-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1750722674OtherNPI
FLHU042YOtherMEDICARE
FL016112400Medicaid
FL08RBROtherBCBS PROVIDER