Provider Demographics
NPI:1013175082
Name:SANDERS, PRISCILLA D (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2728
Mailing Address - Country:US
Mailing Address - Phone:616-836-1819
Mailing Address - Fax:
Practice Address - Street 1:650 RILEY ST
Practice Address - Street 2:SUITE E
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1592
Practice Address - Country:US
Practice Address - Phone:616-836-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010866231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical