Provider Demographics
NPI:1124158613
Name:MORTIMER, SANDRA KLINE (LPC,DAPA,MDIV,NCC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KLINE
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:LPC,DAPA,MDIV,NCC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:KLINE
Other - Last Name:MORTIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC,DAPA,MDIV,NCC
Mailing Address - Street 1:213 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3221
Mailing Address - Country:US
Mailing Address - Phone:304-263-0345
Mailing Address - Fax:304-263-0367
Practice Address - Street 1:213 W JOHN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3221
Practice Address - Country:US
Practice Address - Phone:304-263-0345
Practice Address - Fax:304-263-0367
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional