Provider Demographics
NPI:1780058115
Name:SANDERSON, MICHELLE (LPCC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 DRAGOON RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4475
Mailing Address - Country:US
Mailing Address - Phone:505-228-1670
Mailing Address - Fax:
Practice Address - Street 1:5808 MCLEOD RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2455
Practice Address - Country:US
Practice Address - Phone:505-228-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NMCTB20230886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT-0177011OtherSTATE COUNSELING BOARD