Provider Demographics
NPI:1114150026
Name:DEAN, SANDRA JEAN (LAPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:DEAN
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 DEER TRAIL LAKES DR
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-2110
Mailing Address - Country:US
Mailing Address - Phone:706-839-4284
Mailing Address - Fax:
Practice Address - Street 1:786 RIVERBEND RD
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-5530
Practice Address - Country:US
Practice Address - Phone:706-216-6356
Practice Address - Fax:706-265-6295
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health