Provider Demographics
NPI:1316908262
Name:SANDIDGE, PEGGY G (MED LPC MHSP)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:G
Last Name:SANDIDGE
Suffix:
Gender:F
Credentials:MED LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2765 EXECUTIVE PK DR NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-559-8989
Mailing Address - Fax:423-559-8984
Practice Address - Street 1:2765 EXECUTIVE PK DR NW
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-559-8989
Practice Address - Fax:423-559-8989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health