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General NPI Number Information
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NPI Number | 1497057830
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Entity Type | Individual
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Provider Name | SANDRA JONES MEMBRIO CAC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 91 DOWLIN FORGE RD C.A.R.A., INC
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City | EXTON
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State | PA
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Zip | 19341-1548
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Country | US
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Telephone | 610-524-2448
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Fax | 610-524-0130
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Provider Business Mailing Address
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Address Line | 91 DOWLIN FORGE RD C.A.R.E, INC.
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City | EXTON
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State | PA
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Zip | 19341-1548
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Country | US
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Telephone | 610-524-2448
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Fax | 610-524-0130
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6588
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License Number State | PA
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