Provider Demographics
NPI:1104068329
Name:NAGY, SANDRA MARIE (MA, LISAC, LAC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:NAGY
Suffix:
Gender:F
Credentials:MA, LISAC, LAC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LISAC, LAC
Mailing Address - Street 1:1239 S JOEY PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-1158
Mailing Address - Country:US
Mailing Address - Phone:520-419-5358
Mailing Address - Fax:520-327-2591
Practice Address - Street 1:110 S CHURCH AVE
Practice Address - Street 2:STE 2070
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1608
Practice Address - Country:US
Practice Address - Phone:520-419-5358
Practice Address - Fax:520-903-0309
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 11660101YA0400X
AZLAC11923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health