Provider Demographics
NPI:1740479666
Name:SANDERS, BRANDI SUZETTE
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:SUZETTE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-2660
Mailing Address - Country:US
Mailing Address - Phone:254-716-8440
Mailing Address - Fax:
Practice Address - Street 1:3225 OZARK ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4338
Practice Address - Country:US
Practice Address - Phone:501-666-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health