Provider Demographics
NPI:1669151874
Name:SANDEVSKI, DIANA LORRAINE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LORRAINE
Last Name:SANDEVSKI
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 1:215 MOUNTAIN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2346
Mailing Address - Country:US
Mailing Address - Phone:850-837-9100
Mailing Address - Fax:
Practice Address - Street 1:215 MOUNTAIN DR STE 106
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2346
Practice Address - Country:US
Practice Address - Phone:850-837-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health