Provider Demographics
NPI:1427262336
Name:RIDENOUR, SANDRA L (PCC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BETHEL RD.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2690
Mailing Address - Country:US
Mailing Address - Phone:614-273-0733
Mailing Address - Fax:614-451-3017
Practice Address - Street 1:1115 BETHEL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2690
Practice Address - Country:US
Practice Address - Phone:614-273-0733
Practice Address - Fax:614-451-3017
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-1516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health