Provider Demographics
NPI:1669734174
Name:SANDERS, JESSICA LORRAINE (LCSW, PIP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LORRAINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 CYPRESS LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-9102
Mailing Address - Country:US
Mailing Address - Phone:205-602-7365
Mailing Address - Fax:251-948-9500
Practice Address - Street 1:209 W JESSAMINE AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2010
Practice Address - Country:US
Practice Address - Phone:205-602-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1821C104100000X
AL0752-1821C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker