Provider Demographics
NPI:1760827299
Name:SANDERS-JOHNSON, NORA M (LADC)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:M
Last Name:SANDERS-JOHNSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 64
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3003
Mailing Address - Country:US
Mailing Address - Phone:702-735-7900
Mailing Address - Fax:702-735-0081
Practice Address - Street 1:3661 S MARYLAND PKWY
Practice Address - Street 2:SUITE 64
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3003
Practice Address - Country:US
Practice Address - Phone:702-735-7900
Practice Address - Fax:702-735-0081
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV906-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)