Provider Demographics
NPI:1962429548
Name:PERINE, SANDRA LOU (MA,LPC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LOU
Last Name:PERINE
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 207B
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-9536
Mailing Address - Country:US
Mailing Address - Phone:304-265-1437
Mailing Address - Fax:
Practice Address - Street 1:907 BRUNSWICK CT
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4807
Practice Address - Country:US
Practice Address - Phone:304-292-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health