Provider Demographics
NPI:1982650479
Name:DINAN, SANDRA L (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:DINAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W BROADWAY
Mailing Address - Street 2:N1
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1271
Mailing Address - Country:US
Mailing Address - Phone:573-825-0093
Mailing Address - Fax:573-239-1124
Practice Address - Street 1:2801 W BROADWAY
Practice Address - Street 2:N1
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1271
Practice Address - Country:US
Practice Address - Phone:573-825-0093
Practice Address - Fax:573-239-1124
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001965101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO174188OtherBLUE SHIELD/BLUE CHOICE
MO534840OtherHEALTHLINK
MO498580646Medicaid
MO498580646Medicaid