Provider Demographics
NPI:1861527194
Name:HOPKO, SANDRA DENISE (MA, LPC-MHSP, CEAP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DENISE
Last Name:HOPKO
Suffix:
Gender:F
Credentials:MA, LPC-MHSP, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ASHLAND LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5808
Mailing Address - Country:US
Mailing Address - Phone:865-803-8805
Mailing Address - Fax:
Practice Address - Street 1:106 ADMINISTRATION RD STE 200
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6954
Practice Address - Country:US
Practice Address - Phone:865-803-8805
Practice Address - Fax:866-949-5930
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519192Medicaid