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General NPI Number Information
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NPI Number | 1144592668
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Entity Type | Organization
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Legal Business Name | SANDRA TOLLIVER LCSW CONSULTING & COUNSELLING
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 1079 SPRUCE ST SUITE A
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City | MARTINSVILLE
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State | VA
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Zip | 24112-4527
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Country | US
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Telephone | 276-732-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 140 JEB STUART RD
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City | MARTINSVILLE
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State | VA
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Zip | 24112-0683
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SANDRA TOLLIVER
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Credential |
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Telephone | 276-732-9588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904000858
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License Number State | VA
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