Provider Demographics
NPI:1255803177
Name:SANDERS, ALEXANDRIA NICOLE (LLPC)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 TURNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1191
Mailing Address - Country:US
Mailing Address - Phone:618-923-2366
Mailing Address - Fax:
Practice Address - Street 1:330 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2121
Practice Address - Country:US
Practice Address - Phone:517-787-7920
Practice Address - Fax:517-787-2440
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801107678101Y00000X
MI6401016991101Y00000X
MI6401222507101YP2500X
TX90097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional