Provider Demographics
NPI:1851106702
Name:BREANNA DESANDRO LPCC LLC
Entity type:Organization
Organization Name:BREANNA DESANDRO LPCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:734-436-1345
Mailing Address - Street 1:4407 VOGEL DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-3116
Mailing Address - Country:US
Mailing Address - Phone:734-476-3646
Mailing Address - Fax:
Practice Address - Street 1:5800 MONROE ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2263
Practice Address - Country:US
Practice Address - Phone:734-436-1345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty