Provider Demographics
NPI:1679802870
Name:SANDERS, DEIDREA (MA)
Entity Type:Individual
Prefix:
First Name:DEIDREA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-3604
Mailing Address - Country:US
Mailing Address - Phone:989-755-4297
Mailing Address - Fax:
Practice Address - Street 1:2127 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-3604
Practice Address - Country:US
Practice Address - Phone:989-327-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251E00000XAgenciesHome Health