Provider Demographics
NPI:1255735338
Name:SANDERS, ANESHA C
Entity type:Individual
Prefix:MRS
First Name:ANESHA
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANESHA
Other - Middle Name:C
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3255 WING ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4638
Mailing Address - Country:US
Mailing Address - Phone:619-538-0988
Mailing Address - Fax:
Practice Address - Street 1:3255 WING ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4638
Practice Address - Country:US
Practice Address - Phone:619-538-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1134571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical