Provider Demographics
NPI:1396059374
Name:SANDERS, SANDRA S (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11816 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72142-9739
Mailing Address - Country:US
Mailing Address - Phone:501-765-1176
Mailing Address - Fax:
Practice Address - Street 1:11816 WILLOW LN
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:AR
Practice Address - Zip Code:72142-9739
Practice Address - Country:US
Practice Address - Phone:501-765-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1597C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical