Provider Demographics
NPI:1689083164
Name:SANDERS, DAVID (LSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1403
Mailing Address - Country:US
Mailing Address - Phone:937-234-3694
Mailing Address - Fax:
Practice Address - Street 1:201 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-1403
Practice Address - Country:US
Practice Address - Phone:937-234-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 144038104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker