Provider Demographics
NPI:1073676094
Name:ANDERSON, SANDRA SUE (MED LPC)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:SUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:549 E MCKELLIPS RD LOT 19
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2552
Mailing Address - Country:US
Mailing Address - Phone:480-644-0443
Mailing Address - Fax:480-644-0443
Practice Address - Street 1:3660 E UNIVERSITY DR STE 6B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6960
Practice Address - Country:US
Practice Address - Phone:480-540-8477
Practice Address - Fax:480-654-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional