Provider Demographics
NPI:1346690062
Name:SANDERS, DALE LAWRENCE
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:LAWRENCE
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:LAWRENCE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4 CREEKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4845
Mailing Address - Country:US
Mailing Address - Phone:267-241-8085
Mailing Address - Fax:
Practice Address - Street 1:4 CREEKSTONE CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4845
Practice Address - Country:US
Practice Address - Phone:267-241-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical