Provider Demographics
NPI:1568949063
Name:DENNIS, SANDRA T (MHS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:T
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 S PINE ST STE C
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3623
Mailing Address - Country:US
Mailing Address - Phone:318-375-2780
Mailing Address - Fax:318-375-2781
Practice Address - Street 1:1028 S PINE ST STE C
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3623
Practice Address - Country:US
Practice Address - Phone:318-375-2780
Practice Address - Fax:318-375-2781
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health