Provider Demographics
NPI:1144626037
Name:VAN DE SANDE, SAYBER (LCPC)
Entity type:Individual
Prefix:
First Name:SAYBER
Middle Name:
Last Name:VAN DE SANDE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HIGH HEAD RD
Mailing Address - Street 2:
Mailing Address - City:EAST MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04630-3851
Mailing Address - Country:US
Mailing Address - Phone:207-259-6022
Mailing Address - Fax:
Practice Address - Street 1:167 HIGH HEAD RD
Practice Address - Street 2:
Practice Address - City:EAST MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04630
Practice Address - Country:US
Practice Address - Phone:207-259-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5497101YA0400X
101YM0800X
MECC4973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1144626037Medicaid