Provider Demographics
NPI:1902911209
Name:COPLON, SANDRA JEAN (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:COPLON
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLUMBUS CTR
Mailing Address - Street 2:SUITE 679
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6722
Mailing Address - Country:US
Mailing Address - Phone:757-635-6093
Mailing Address - Fax:757-523-0653
Practice Address - Street 1:ONE COLUMBUS CENTER
Practice Address - Street 2:SUITE 679
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-490-7801
Practice Address - Fax:757-523-0653
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005643104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010199417Medicaid
VA010199417Medicaid