Provider Demographics
NPI:1750419545
Name:SANDERS, ADMIRAL DEWEY (PHD)
Entity type:Individual
Prefix:DR
First Name:ADMIRAL
Middle Name:DEWEY
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2126
Mailing Address - Country:US
Mailing Address - Phone:859-282-0119
Mailing Address - Fax:
Practice Address - Street 1:7315 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2126
Practice Address - Country:US
Practice Address - Phone:859-282-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist