Provider Demographics
NPI:1174876668
Name:QUALEY, SANDRA J (LCPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:QUALEY
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 1:70 HENNESSEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2837
Mailing Address - Country:US
Mailing Address - Phone:207-267-0051
Mailing Address - Fax:
Practice Address - Street 1:70 HENNESSEY AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2837
Practice Address - Country:US
Practice Address - Phone:207-267-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health