Provider Demographics
NPI:1417378274
Name:CLAMON, SANDRA (MS, LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CLAMON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3002 EDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-3454
Mailing Address - Country:US
Mailing Address - Phone:719-960-7597
Mailing Address - Fax:
Practice Address - Street 1:3002 EDINGTON DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-3454
Practice Address - Country:US
Practice Address - Phone:719-960-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTMPC1835101Y00000X
COLPC0014805101Y00000X
101YM0800X
TX81064101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health