Healthcare Provider Details

I. General information

NPI: 1104986389
Provider Name (Legal Business Name): SANDRA MARIE FARLEY M.S., LPC, AADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 ROUTE 65
DELBARTON WV
25670-7234
US

IV. Provider business mailing address

1125 ROUTE 65
DELBARTON WV
25670-7234
US

V. Phone/Fax

Practice location:
  • Phone: 980-825-9878
  • Fax:
Mailing address:
  • Phone: 980-825-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1165
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5190
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: