Provider Demographics
NPI:1780839969
Name:SANDERS, ROSE MARY (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARY
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:ROSE
Other - Middle Name:MARY
Other - Last Name:PAMPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6210 BERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7909
Mailing Address - Country:US
Mailing Address - Phone:601-362-8798
Mailing Address - Fax:
Practice Address - Street 1:6210 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7909
Practice Address - Country:US
Practice Address - Phone:601-362-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCO344104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker