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General NPI Number Information
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NPI Number | 1184936866
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Entity Type | Individual
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Provider Name | SANDRA LYNN GROOM LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 1415 VICTOR AVE
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City | REDDING
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State | CA
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Zip | 96003-4879
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Country | US
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Telephone | 530-338-6549
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Fax | 530-605-0281
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Provider Business Mailing Address
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Address Line | PO BOX 491553
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City | REDDING
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State | CA
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Zip | 96049-1553
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Country | US
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Telephone | 530-338-6549
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Fax | 530-605-0281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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