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General NPI Number Information
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NPI Number | 1386049435
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Entity Type | Individual
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Provider Name | SANDRA IVELISSE SOSA-CARLIN ED.D, NCC, LMHC, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 150 GARDEN WALK
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7324
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Country | US
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Telephone | 404-759-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 4613 CORSAGE DR
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City | LUTZ
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State | FL
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Zip | 33558-9212
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Country | US
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Telephone | 404-759-8484
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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 | LPC008058
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 1245617
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 772021
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH25330
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License Number State | FL
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