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General NPI Number Information
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NPI Number | 1720377187
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Entity Type | Individual
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Provider Name | SACRA DURANDISSE M.S.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 462 BRACKENWOOD LN S
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-9051
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Country | US
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Telephone | 561-670-7498
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Fax |
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Provider Business Mailing Address
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Address Line | 1348 W 32ND ST
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-3562
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Country | US
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Telephone | 407-731-6656
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61085561
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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