Provider Demographics
NPI:1497126049
Name:AMY SANDERSON
Entity Type:Organization
Organization Name:AMY SANDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA, NCC
Authorized Official - Phone:248-396-8810
Mailing Address - Street 1:401 DEER BRUSH LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6307
Mailing Address - Country:US
Mailing Address - Phone:248-396-8810
Mailing Address - Fax:
Practice Address - Street 1:401 DEER BRUSH LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6307
Practice Address - Country:US
Practice Address - Phone:248-396-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11665251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health