Provider Demographics
NPI:1558905877
Name:SANDERS, ANGELIQUE (LMHC)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 MILL CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-9014
Mailing Address - Country:US
Mailing Address - Phone:850-776-5245
Mailing Address - Fax:
Practice Address - Street 1:308 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5969
Practice Address - Country:US
Practice Address - Phone:850-807-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health