Provider Demographics
NPI:1003148693
Name:SANDERS, MARKESHA ANTONETTE
Entity Type:Individual
Prefix:
First Name:MARKESHA
Middle Name:ANTONETTE
Last Name:SANDERS
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 1:708 W 138TH ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3514
Mailing Address - Country:US
Mailing Address - Phone:310-256-7066
Mailing Address - Fax:
Practice Address - Street 1:708 W 138TH ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-3514
Practice Address - Country:US
Practice Address - Phone:310-256-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)