Provider Demographics
NPI:1285092270
Name:WHITE, SANDRA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 PRADO DEL SOL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4330
Mailing Address - Country:US
Mailing Address - Phone:915-525-6483
Mailing Address - Fax:
Practice Address - Street 1:2541 PRADO DEL SOL AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4330
Practice Address - Country:US
Practice Address - Phone:915-525-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker