Provider Demographics
NPI:1417504432
Name:SANDER, EMILY (LGPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SANDER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8258 VETERANS HWY STE 13
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1564
Mailing Address - Country:US
Mailing Address - Phone:410-768-6088
Mailing Address - Fax:410-768-6444
Practice Address - Street 1:8258 VETERANS HWY STE 13
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1564
Practice Address - Country:US
Practice Address - Phone:410-768-6088
Practice Address - Fax:410-768-6444
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health