Healthcare Provider Details

I. General information

NPI: 1851593727
Provider Name (Legal Business Name): SANDRA GAYLE CARO LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 AVENUE K
LUBBOCK TX
79401-5042
US

IV. Provider business mailing address

502 PHILLIPS BLVD APT C
ABERNATHY TX
79311-2100
US

V. Phone/Fax

Practice location:
  • Phone: 806-763-7633
  • Fax: 806-765-0130
Mailing address:
  • Phone: 806-298-2311
  • Fax: 806-765-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: