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General NPI Number Information
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NPI Number | 1598475915
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Entity Type | Individual
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Provider Name | SANDRA MIA SUONG MS MFT
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Gender | Female
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1250 E WALNUT ST STE 110
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City | PASADENA
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State | CA
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Zip | 91106-1877
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Country | US
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Telephone | 818-370-5993
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Fax |
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Provider Business Mailing Address
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Address Line | 330 CONCORD ST APT B
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City | GLENDALE
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State | CA
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Zip | 91203-2800
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Country | US
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Telephone | 818-370-5993
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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 | 48853
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License Number State | CA
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