=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538243241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA S QUARLES LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 02/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 LYNNHAVEN PKWY STE 100
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-7411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-385-2132
-----------------------------------------------------
Fax | 757-427-2480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221A 63RD ST
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23451-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-270-9170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904000159
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------