Provider Demographics
NPI:1730889239
Name:LITCHMORE, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LITCHMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6232 BELDON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8007
Mailing Address - Country:US
Mailing Address - Phone:904-535-5112
Mailing Address - Fax:
Practice Address - Street 1:3722 MEADOW GREEN DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-9481
Practice Address - Country:US
Practice Address - Phone:904-535-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW210501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical