Provider Demographics
NPI:1982036539
Name:SANDERS, TAYA LARENKOVA (MS, LAPC, NCC)
Entity Type:Individual
Prefix:
First Name:TAYA
Middle Name:LARENKOVA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:TAYISIYA
Other - Middle Name:LARENKOVA
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LAPC, NCC
Mailing Address - Street 1:2215 CHESHIRE BRIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4234
Mailing Address - Country:US
Mailing Address - Phone:404-576-4006
Mailing Address - Fax:
Practice Address - Street 1:2215 CHESHIRE BRIDGE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4234
Practice Address - Country:US
Practice Address - Phone:404-576-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional