Provider Demographics
NPI:1427182021
Name:SANDERS, ROSINE LAWANDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSINE
Middle Name:LAWANDA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ROSINE
Other - Middle Name:LAWANDA
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3900 BARRETT DR STE 311H
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6646
Mailing Address - Country:US
Mailing Address - Phone:919-332-4114
Mailing Address - Fax:919-844-8104
Practice Address - Street 1:3900 BARRETT DR STE 311H
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6646
Practice Address - Country:US
Practice Address - Phone:919-332-4114
Practice Address - Fax:919-844-8104
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000766Medicaid