Provider Demographics
NPI:1386049435
Name:SOSA-CARLIN, SANDRA IVELISSE (EDD, NCC, LMHC, LPC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:IVELISSE
Last Name:SOSA-CARLIN
Suffix:
Gender:F
Credentials:EDD, NCC, LMHC, LPC
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:IVELISSE
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, NCC, LPC
Mailing Address - Street 1:4613 CORSAGE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9212
Mailing Address - Country:US
Mailing Address - Phone:404-759-8484
Mailing Address - Fax:
Practice Address - Street 1:150 GARDEN WALK
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7324
Practice Address - Country:US
Practice Address - Phone:404-759-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008058101YP2500X
FL1245617101YS0200X
GA772021101YS0200X
FLMH25330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool