Provider Demographics
NPI:1265617435
Name:SANDERS, TOMMIE D (ADC, LPC)
Entity type:Individual
Prefix:
First Name:TOMMIE
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 COUNTY ROAD 1545
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-2022
Mailing Address - Country:US
Mailing Address - Phone:256-595-9513
Mailing Address - Fax:
Practice Address - Street 1:1909 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-6151
Practice Address - Country:US
Practice Address - Phone:256-734-4688
Practice Address - Fax:256-255-0026
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3255101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL590000025Medicaid
AL330000025Medicaid