Provider Demographics
NPI:1629847710
Name:SANDERS, PAUL D II (CADC, CPSS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:SANDERS
Suffix:II
Gender:M
Credentials:CADC, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 OLD MILL FORD TRL
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-8262
Mailing Address - Country:US
Mailing Address - Phone:980-428-5970
Mailing Address - Fax:
Practice Address - Street 1:350 N COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5566
Practice Address - Country:US
Practice Address - Phone:336-629-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-22392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)