Provider Demographics
NPI:1417562265
Name:SANDERS, MICHELLE DION (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DION
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MIERWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-222-0386
Mailing Address - Fax:701-255-4891
Practice Address - Street 1:101 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-222-0386
Practice Address - Fax:701-255-4891
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1889101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)