Provider Demographics
NPI:1154717163
Name:SANDFORD, GLORIA MARIE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIE
Last Name:SANDFORD
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:SANDFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:1818 WESTLAKE AVE N STE 312
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2707
Mailing Address - Country:US
Mailing Address - Phone:206-303-8506
Mailing Address - Fax:
Practice Address - Street 1:1818 WESTLAKE AVE N STE 312
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2707
Practice Address - Country:US
Practice Address - Phone:206-303-8506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH00005224101YM0800X
WALH 00005224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health