Provider Demographics
NPI:1932816535
Name:SALLEE, DUSTINA RENAE (MASTER IN PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:DUSTINA
Middle Name:RENAE
Last Name:SALLEE
Suffix:
Gender:F
Credentials:MASTER IN PSYCHOLOGY
Other - Prefix:
Other - First Name:DUSTINA
Other - Middle Name:RENAE
Other - Last Name:SALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTER IN PSYCHOLOGY
Mailing Address - Street 1:200 FERRY ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1172
Mailing Address - Country:US
Mailing Address - Phone:317-296-5332
Mailing Address - Fax:
Practice Address - Street 1:200 FERRY ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1172
Practice Address - Country:US
Practice Address - Phone:317-296-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)