Provider Demographics
NPI:1326234188
Name:SANDERS, SANDRA (SANDY) J (LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA (SANDY)
Middle Name:J
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SANDRA (SANDY)
Other - Middle Name:J
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9705 CROXTED RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-9244
Mailing Address - Country:US
Mailing Address - Phone:479-646-0662
Mailing Address - Fax:
Practice Address - Street 1:9705 CROXTED RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-9244
Practice Address - Country:US
Practice Address - Phone:479-646-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8709017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional