Provider Demographics
NPI:1154744340
Name:SIDERS, DAYNA A (MS, LPC)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:A
Last Name:SIDERS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1928
Mailing Address - Country:US
Mailing Address - Phone:937-280-2000
Mailing Address - Fax:937-280-2051
Practice Address - Street 1:300 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1928
Practice Address - Country:US
Practice Address - Phone:937-280-2000
Practice Address - Fax:937-280-2051
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1000274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional