Provider Demographics
NPI:1689107690
Name:MESSINA, SANDRA A (LCDCII, SWA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:MESSINA
Suffix:
Gender:F
Credentials:LCDCII, SWA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:MESSINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:62 E STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5969
Mailing Address - Country:US
Mailing Address - Phone:740-366-7303
Mailing Address - Fax:740-366-7305
Practice Address - Street 1:62 E STEVENS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5969
Practice Address - Country:US
Practice Address - Phone:740-366-7303
Practice Address - Fax:740-366-7305
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081025101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)