Provider Demographics
NPI:1871831826
Name:SANDERS, INDIA LYNNE (LAC, LMBT)
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:LYNNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LAC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6768 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8464
Mailing Address - Country:US
Mailing Address - Phone:910-547-3919
Mailing Address - Fax:
Practice Address - Street 1:6768 GORDON RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8464
Practice Address - Country:US
Practice Address - Phone:910-547-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC656171100000X
NC4127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist