Provider Demographics
NPI:1760653554
Name:SANDOVAL, DIANNA LYNN (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LYNN
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-1950
Mailing Address - Country:US
Mailing Address - Phone:303-359-1352
Mailing Address - Fax:303-835-2534
Practice Address - Street 1:1401 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1950
Practice Address - Country:US
Practice Address - Phone:303-359-1352
Practice Address - Fax:303-835-2534
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3395101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)