Provider Demographics
NPI:1750164562
Name:SANDERSON, MELANIE KARLS (LGPAT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:KARLS
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LGPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 TIMBERCREST DR
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5651
Mailing Address - Country:US
Mailing Address - Phone:443-564-5868
Mailing Address - Fax:
Practice Address - Street 1:914 SILVER SPRING AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4621
Practice Address - Country:US
Practice Address - Phone:301-588-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATG274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health