Provider Demographics
NPI:1316264344
Name:WOOLSEY, SANDRA J (MA LPCC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2462 16TH AVE E
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2336
Mailing Address - Country:US
Mailing Address - Phone:651-773-1991
Mailing Address - Fax:
Practice Address - Street 1:348 PRIOR AVE N
Practice Address - Street 2:SUITE 206
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5187
Practice Address - Country:US
Practice Address - Phone:651-646-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist