Healthcare Provider Details

I. General information

NPI: 1912299637
Provider Name (Legal Business Name): SANDRA MASSEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 J D PARK RD STE 2
LEWISBURG WV
24901-9034
US

IV. Provider business mailing address

PO BOX 243
MAXWELTON WV
24957-0243
US

V. Phone/Fax

Practice location:
  • Phone: 304-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006040
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: