Provider Demographics
NPI:1184219099
Name:SANDERS, JENNIFER (LCMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JOHNSON POINT RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-7042
Mailing Address - Country:US
Mailing Address - Phone:252-515-0122
Mailing Address - Fax:
Practice Address - Street 1:312 S FRONT ST STE 6
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-2134
Practice Address - Country:US
Practice Address - Phone:252-515-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14573101YM0800X
NC14572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health