Provider Demographics
NPI:1730133000
Name:SANDERS, FELICITY L (PHD)
Entity Type:Individual
Prefix:
First Name:FELICITY
Middle Name:L
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 ROBESON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5549
Mailing Address - Country:US
Mailing Address - Phone:910-609-1990
Mailing Address - Fax:910-609-1993
Practice Address - Street 1:2411 ROBESON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5549
Practice Address - Country:US
Practice Address - Phone:910-609-1990
Practice Address - Fax:910-609-1993
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3886103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001190Medicaid
NC2826028OtherMEDICARE ID
NC268021OtherCOMPSYCH
NC015J8OtherBCBSNC GROUP
NC141VCOtherBCBSNC INDIVIDUAL