Individual
SANDRA DIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
301 SOVEREIGN CT, BALLWIN, MO 63011-4441
(636) 200-8171
Mailing address
15831 BARONS WAY DR, CHESTERFIELD, MO 63017-7111
(131) 476-6223
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2015026374
MO
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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