Provider Demographics
NPI:1437931052
Name:SANDERS, ANTHONY JORO (MA, TLLP, DP-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JORO
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MA, TLLP, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53323 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5734
Mailing Address - Country:US
Mailing Address - Phone:586-676-7818
Mailing Address - Fax:
Practice Address - Street 1:54 SENECA ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2349
Practice Address - Country:US
Practice Address - Phone:248-836-0191
Practice Address - Fax:248-836-0199
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical