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General NPI Number Information
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NPI Number | 1629667159
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Entity Type | Individual
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Provider Name | SANDRA BROOKS LSATP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 4211 WALNEY RD
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City | CHANTILLY
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State | VA
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Zip | 20151-2923
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Country | US
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Telephone | 703-227-7100
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Fax | 703-322-1631
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Provider Business Mailing Address
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Address Line | 4211 WALNEY RD
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City | CHANTILLY
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State | VA
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Zip | 20151-2923
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Country | US
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Telephone | 703-227-7100
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Fax | 703-322-1631
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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 | LCAS
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0718000494
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License Number State | VA
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