Provider Demographics
NPI:1891460309
Name:DEVILLE, SANDRALEE
Entity type:Individual
Prefix:
First Name:SANDRALEE
Middle Name:
Last Name:DEVILLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27431 SAN BERNARDINO AVE APT 227
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-5085
Mailing Address - Country:US
Mailing Address - Phone:909-732-2731
Mailing Address - Fax:
Practice Address - Street 1:4280 LATHAM ST STE G
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1737
Practice Address - Country:US
Practice Address - Phone:909-295-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1246471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical