Provider Demographics
NPI:1700110566
Name:SANDERS, MARY ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32231 SCHOOLCRAFT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4322
Mailing Address - Country:US
Mailing Address - Phone:734-266-6800
Mailing Address - Fax:734-266-6015
Practice Address - Street 1:9000 E JEFFERSON AVE APT 9-6
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2962
Practice Address - Country:US
Practice Address - Phone:313-729-7641
Practice Address - Fax:313-729-7641
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082384101YA0400X, 101YM0800X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool