Provider Demographics
NPI:1790957959
Name:SANDERS, TRUMAINE RODERICK (LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:TRUMAINE
Middle Name:RODERICK
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 POINT SOUTH DR APT J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6570
Mailing Address - Country:US
Mailing Address - Phone:704-756-5254
Mailing Address - Fax:
Practice Address - Street 1:10912 POINT SOUTH DR APT J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6570
Practice Address - Country:US
Practice Address - Phone:704-756-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC2844-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health