Provider Demographics
NPI:1922246651
Name:SANDERS, JEAN MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 BRAMFORD WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1337
Mailing Address - Country:US
Mailing Address - Phone:216-402-0954
Mailing Address - Fax:
Practice Address - Street 1:340 BRAMFORD WAY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1337
Practice Address - Country:US
Practice Address - Phone:216-402-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA267101Y00000X
GACAC11-1903101YA0400X
OHLPC 0012407101YM0800X
GALPC 005232101YP2500X
OHS 0012407104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker