Provider Demographics
NPI:1922349463
Name:SANDERS, SANDY LATRICE
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:LATRICE
Last Name:SANDERS
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 1:929 BARITONE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7898
Mailing Address - Country:US
Mailing Address - Phone:702-764-9676
Mailing Address - Fax:
Practice Address - Street 1:929 BARITONE WAY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7898
Practice Address - Country:US
Practice Address - Phone:702-764-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health