Provider Demographics
NPI:1225699341
Name:LOMBARDO, DIDI (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DIDI
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:DORCAS
Other - Middle Name:
Other - Last Name:LOMBARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:11469 OLIVE BLVD # 1107
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7108
Mailing Address - Country:US
Mailing Address - Phone:314-472-3566
Mailing Address - Fax:
Practice Address - Street 1:11469 OLIVE BLVD # 1107
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7108
Practice Address - Country:US
Practice Address - Phone:314-472-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017011237101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor