Provider Demographics
NPI:1487006391
Name:SANDERS, GERALD CINTRELL SR
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:CINTRELL
Last Name:SANDERS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 N MOLE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1124
Mailing Address - Country:US
Mailing Address - Phone:215-820-1620
Mailing Address - Fax:215-924-2014
Practice Address - Street 1:4531 N MOLE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-1124
Practice Address - Country:US
Practice Address - Phone:215-820-1620
Practice Address - Fax:215-924-2014
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health