Provider Demographics
NPI:1124141718
Name:O'DONNELL, SANDRA SUE (LPC-MHSP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:SUE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:SUE
Other - Last Name:DERREBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1213 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2723
Mailing Address - Country:US
Mailing Address - Phone:615-390-6439
Mailing Address - Fax:
Practice Address - Street 1:2021 RICHARD JONES RD
Practice Address - Street 2:SUITE 110
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2860
Practice Address - Country:US
Practice Address - Phone:615-598-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional