Provider Demographics
NPI:1780563403
Name:SANDINE, LISA JANINE
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:JANINE
Last Name:SANDINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17249 SW GREENGATE DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-6927
Mailing Address - Country:US
Mailing Address - Phone:505-231-0404
Mailing Address - Fax:
Practice Address - Street 1:10580 SW MCDONALD ST STE 202
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4800
Practice Address - Country:US
Practice Address - Phone:971-242-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health