Provider Demographics
NPI:1205823804
Name:SANDERS, VIRGINIA SUSAN (LCSW-ACP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:SUSAN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW-ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 BEE CAVES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5802
Mailing Address - Country:US
Mailing Address - Phone:512-306-1776
Mailing Address - Fax:512-306-1776
Practice Address - Street 1:3160 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5802
Practice Address - Country:US
Practice Address - Phone:512-306-1776
Practice Address - Fax:512-306-1776
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00255EMedicare ID - Type Unspecified