Provider Demographics
NPI:1083110944
Name:SANDERS COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SANDERS COUNSELING ASSOCIATES, LLC
Other - Org Name:SANDERS COUNSELING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:662-425-1176
Mailing Address - Street 1:501 7TH ST N STE 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4683
Mailing Address - Country:US
Mailing Address - Phone:662-425-1176
Mailing Address - Fax:
Practice Address - Street 1:501 7TH ST N STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4683
Practice Address - Country:US
Practice Address - Phone:662-425-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1367261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05837260Medicaid