Provider Demographics
NPI:1255435202
Name:SANDERS, GWEN (MFT, ATR-BC)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3873 PIEDMONT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5370
Mailing Address - Country:US
Mailing Address - Phone:510-869-3901
Mailing Address - Fax:510-317-1144
Practice Address - Street 1:3873 PIEDMONT AVE STE 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5370
Practice Address - Country:US
Practice Address - Phone:510-869-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist