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General NPI Number Information
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NPI Number | 1316264344
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Entity Type | Individual
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Provider Name | SANDRA J. WOOLSEY M.A. LPCC
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Gender | Female
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 348 PRIOR AVE N SUITE 206
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City | SAINT PAUL
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State | MN
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Zip | 55104-5187
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Country | US
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Telephone | 651-646-1488
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Fax |
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Provider Business Mailing Address
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Address Line | 2462 16TH AVE E
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City | NORTH ST PAUL
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State | MN
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Zip | 55109-2336
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Country | US
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Telephone | 651-773-1991
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | CC00153
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License Number State | MN
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