Provider Demographics
NPI:1629309679
Name:SANDERS, LECOLE JOHNSON (LISW)
Entity Type:Individual
Prefix:MRS
First Name:LECOLE
Middle Name:JOHNSON
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4184
Mailing Address - Country:US
Mailing Address - Phone:843-661-6030
Mailing Address - Fax:
Practice Address - Street 1:1803 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4184
Practice Address - Country:US
Practice Address - Phone:843-661-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical