Healthcare Provider Details

I. General information

NPI: 1316297393
Provider Name (Legal Business Name): SANDRA NORRIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MIDDLEBROOK AVE
STAUNTON VA
24401-4233
US

IV. Provider business mailing address

11 MIDDLEBROOK AVE
STAUNTON VA
24401-4233
US

V. Phone/Fax

Practice location:
  • Phone: 540-949-7045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005282
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: