Provider Demographics
NPI:1750440780
Name:LODICO, SANDRA IRENE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:IRENE
Last Name:LODICO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3788 E MARILYNS LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8885
Mailing Address - Country:US
Mailing Address - Phone:989-835-8344
Mailing Address - Fax:989-835-8344
Practice Address - Street 1:3788 E MARILYNS LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8885
Practice Address - Country:US
Practice Address - Phone:989-835-8344
Practice Address - Fax:989-835-8344
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional