Provider Demographics
NPI:1790658821
Name:ATILANO, SANDRA RUBI (LCDC-I)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:RUBI
Last Name:ATILANO
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-5247
Mailing Address - Country:US
Mailing Address - Phone:956-428-7800
Mailing Address - Fax:
Practice Address - Street 1:1806 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5247
Practice Address - Country:US
Practice Address - Phone:956-428-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)