Provider Demographics
NPI:1275860835
Name:SANDERS, CHRISTIAN AUGUSTINE (LCSW, LMSW, LADAC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:AUGUSTINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW, LMSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1346
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-1346
Mailing Address - Country:US
Mailing Address - Phone:970-570-9933
Mailing Address - Fax:
Practice Address - Street 1:691 E EMPIRE ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2802
Practice Address - Country:US
Practice Address - Phone:970-565-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99-07-18101YA0400X
NM0125511101YA0400X
AZ13004104100000X
COCSW.099239211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker