Individual
SANDRA J TOBIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMHC, LSW, CEAP
Contact information
Practice address
909 E STATE BLVD, C/O PARK CENTER, FORT WAYNE, IN 46805-3404
(260) 267-6137
Mailing address
1110 CLARA AVE, FORT WAYNE, IN 46805-3514
(260) 267-6137
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000100A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11784300
CAQH
IN
Enumeration date
07/25/2006
Last updated
09/19/2012
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