Provider Demographics
NPI:1649733247
Name:SANDERS, JONATHAN (MS, CRC, LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 HOOVER CT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3622
Mailing Address - Country:US
Mailing Address - Phone:256-485-6626
Mailing Address - Fax:
Practice Address - Street 1:1957 HOOVER CT
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-3622
Practice Address - Country:US
Practice Address - Phone:256-485-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3985101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor