Provider Demographics
NPI:1407940919
Name:DEARDORFF, JANA C (LPC)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:C
Last Name:DEARDORFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:C
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2214 AFTON WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2002
Mailing Address - Country:US
Mailing Address - Phone:719-400-8578
Mailing Address - Fax:936-271-4968
Practice Address - Street 1:1843 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-400-8578
Practice Address - Fax:936-271-4968
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4549101YM0800X
CO14432101YP2500X
TX73664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health