Healthcare Provider Details

I. General information

NPI: 1306514088
Provider Name (Legal Business Name): SANDRA RENEE PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3058 STANTON RD SE APT 203
WASHINGTON DC
20020-7886
US

IV. Provider business mailing address

3700 9TH ST SE APT 726
WASHINGTON DC
20032-4004
US

V. Phone/Fax

Practice location:
  • Phone: 202-883-9012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: