Provider Demographics
NPI:1467228387
Name:SANDERSON, THERESE MARIE (LPC, PHD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:BEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:100 RABOLD DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8645
Mailing Address - Country:US
Mailing Address - Phone:412-495-2895
Mailing Address - Fax:
Practice Address - Street 1:4001 STONEWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8398
Practice Address - Country:US
Practice Address - Phone:412-923-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361004435103T00000X
PAPC006871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist