Provider Demographics
NPI:1447518899
Name:CONWAY, SANDRA STEPHENS (LMHC, CAP, NCC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:STEPHENS
Last Name:CONWAY
Suffix:
Gender:F
Credentials:LMHC, CAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12945 SEMINOLE BLVD
Mailing Address - Street 2:BLDG ONE, STE 12
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2319
Mailing Address - Country:US
Mailing Address - Phone:727-644-6770
Mailing Address - Fax:
Practice Address - Street 1:12945 SEMINOLE BLVD
Practice Address - Street 2:BLDG ONE, STE 12
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2319
Practice Address - Country:US
Practice Address - Phone:727-644-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP2872101YA0400X
FLMH4905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)