Provider Demographics
NPI:1922723113
Name:SANDERS, MICQUEL (LMSW, LSSW)
Entity Type:Individual
Prefix:
First Name:MICQUEL
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 OLD HICKORY BLVD UNIT 43
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3958
Mailing Address - Country:US
Mailing Address - Phone:502-418-1856
Mailing Address - Fax:
Practice Address - Street 1:350 HART LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-3418
Practice Address - Country:US
Practice Address - Phone:502-418-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0007265391041S0200X
TNLSW0000013684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool