Provider Demographics
NPI:1922438555
Name:SANDERS, AISHA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:AISHA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 S WOODLAWN AVE
Mailing Address - Street 2:2N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3706
Mailing Address - Country:US
Mailing Address - Phone:773-430-0084
Mailing Address - Fax:708-799-0300
Practice Address - Street 1:17504 E CARRIAGEWAY DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2087
Practice Address - Country:US
Practice Address - Phone:708-799-0300
Practice Address - Fax:708-799-0300
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional