Provider Demographics
NPI:1851922959
Name:SANCHEZ, CHANNELL CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHANNELL
Middle Name:CHRISTINE
Last Name:SANCHEZ
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 1:11418 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4103
Mailing Address - Country:US
Mailing Address - Phone:504-289-0984
Mailing Address - Fax:
Practice Address - Street 1:11418 BRANDYWINE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4103
Practice Address - Country:US
Practice Address - Phone:504-289-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001604103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty