Provider Demographics
NPI:1821396920
Name:SANDERS, JAMES FORREST (PSYD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FORREST
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 LEWIS MOUNTAIN RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2463
Mailing Address - Country:US
Mailing Address - Phone:660-726-2896
Mailing Address - Fax:
Practice Address - Street 1:1960 LEWIS MOUNTAIN RD
Practice Address - Street 2:UNIT 1
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2463
Practice Address - Country:US
Practice Address - Phone:660-726-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4157103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist