Provider Demographics
NPI:1891043238
Name:SANDERS, TIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TIA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:RANCOCAS
Mailing Address - State:NJ
Mailing Address - Zip Code:08073-0652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 ROUTE 73 S
Practice Address - Street 2:STE 306B
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9642
Practice Address - Country:US
Practice Address - Phone:609-817-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054926001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical