Individual
NICOLE RAE SANDLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
500 WHITESBORO ST, UTICA, NY 13502-3015
(315) 724-5168
Mailing address
500 WHITESBORO ST, UTICA, NY 13502-3015
(315) 724-5168
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
32336
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271578278
—
NY
Enumeration date
04/06/2022
Last updated
03/25/2024
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