Provider Demographics
NPI:1669978979
Name:SANDERS, KRISTIN ELISE (CNDAI/CNDCS/DD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELISE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CNDAI/CNDCS/DD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:E
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNDAI/CNDCS/DD
Mailing Address - Street 1:1206 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4080
Mailing Address - Country:US
Mailing Address - Phone:740-819-3303
Mailing Address - Fax:
Practice Address - Street 1:1206 ELM ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4080
Practice Address - Country:US
Practice Address - Phone:740-819-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00036101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)