Provider Demographics
NPI:1467905943
Name:SANDERS, MICHAEL CARROLL (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CARROLL
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 PRITCHARD RD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6007
Mailing Address - Country:US
Mailing Address - Phone:504-341-4869
Mailing Address - Fax:504-341-6548
Practice Address - Street 1:2601 N HULLEN ST STE 136
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5900
Practice Address - Country:US
Practice Address - Phone:504-341-4869
Practice Address - Fax:504-341-6548
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional