Provider Demographics
NPI:1306953898
Name:PATE, SANDRA S (PHD, LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:PATE
Suffix:
Gender:F
Credentials:PHD, LCSW, ACSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:S
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9127 TETON COURT
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-925-3400
Mailing Address - Fax:479-925-3133
Practice Address - Street 1:9127 TETON COURT
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-925-3400
Practice Address - Fax:479-925-3133
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-907101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
041018OtherMHN
5S828Medicare ID - Type Unspecified