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General NPI Number Information
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NPI Number | 1215474432
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Entity Type | Individual
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Provider Name | SANDRA BORDALLO MA, COUNSELING
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Gender | Female
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 261A OLD PRICE ROAD
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City | MANGILAO
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State | GUAM
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Zip | 96923
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Country | UM
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Telephone | 671-888-9177
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 27594
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City | BARRIGADA
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State | GUAM
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Zip | 96921
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Country | UM
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Telephone | 671-888-9177
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-109
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License Number State | GU
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