Provider Demographics
NPI:1619090339
Name:SANFORD, DIANA W (LMHC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:W
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 RUE JOLIE LN
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-9035
Mailing Address - Country:US
Mailing Address - Phone:509-662-3058
Mailing Address - Fax:
Practice Address - Street 1:23 S WENATCHEE AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2264
Practice Address - Country:US
Practice Address - Phone:509-664-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00004833OtherLICENSE