Provider Demographics
NPI:1578714630
Name:SANDERS, ROBIN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 COUNTRY CLUB AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3300
Mailing Address - Country:US
Mailing Address - Phone:479-222-6806
Mailing Address - Fax:479-222-6665
Practice Address - Street 1:3514 COUNTRY CLUB AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3300
Practice Address - Country:US
Practice Address - Phone:479-222-6806
Practice Address - Fax:479-222-6665
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0708059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health