Provider Demographics
NPI:1306533682
Name:VAN SANDT, JEANNINE RENEA (LCMHCA)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:RENEA
Last Name:VAN SANDT
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N MERRIMON AVE UNIT 302
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1394
Mailing Address - Country:US
Mailing Address - Phone:828-808-5467
Mailing Address - Fax:
Practice Address - Street 1:60 N MERRIMON AVE UNIT 302
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1394
Practice Address - Country:US
Practice Address - Phone:828-808-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health