Healthcare Provider Details

I. General information

NPI: 1699284562
Provider Name (Legal Business Name): MARIAMA COOK SANDIFER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 OLIVE ST
NEW ORLEANS LA
70118-2446
US

IV. Provider business mailing address

9012 OLIVE ST
NEW ORLEANS LA
70118-2446
US

V. Phone/Fax

Practice location:
  • Phone: 504-957-7726
  • Fax:
Mailing address:
  • Phone: 504-957-7726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC011167
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: