Provider Demographics
NPI:1134741440
Name:CARBAJAL, SANDRA (LMHC, LCAC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 INDIANA AVE STE G5
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6182
Mailing Address - Country:US
Mailing Address - Phone:219-224-5563
Mailing Address - Fax:
Practice Address - Street 1:257 INDIANA AVE STE G5
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6182
Practice Address - Country:US
Practice Address - Phone:219-224-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004025A101YP2500X
IN88000804A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty