Provider Demographics
NPI:1902404619
Name:SAMARDZICH, DANA LYNN (LHMC, NCC, PCC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:SAMARDZICH
Suffix:
Gender:F
Credentials:LHMC, NCC, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 LINCOLNWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-5802
Mailing Address - Country:US
Mailing Address - Phone:192-203-3225
Mailing Address - Fax:
Practice Address - Street 1:1158 LINCOLNWAY STE 3
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-5802
Practice Address - Country:US
Practice Address - Phone:192-203-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004643A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health