Provider Demographics
NPI:1538243241
Name:QUARLES, SANDRA S (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:QUARLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221A 63RD ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-2124
Mailing Address - Country:US
Mailing Address - Phone:757-270-9170
Mailing Address - Fax:
Practice Address - Street 1:309 LYNNHAVEN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7411
Practice Address - Country:US
Practice Address - Phone:757-385-2132
Practice Address - Fax:757-427-2480
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040001591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945395Medicaid
VA081144MOtherSENTARA
VACO3533OtherMCR GROUP
VA174570OtherANTHEM
VA174570OtherHKP
VA004945395OtherVA PREMIER
VA081144MOtherSENTARA
VA004945395OtherVA PREMIER