Provider Demographics
NPI:1912698036
Name:SANDERS, KRISTINA D (PLADC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2618
Mailing Address - Country:US
Mailing Address - Phone:308-763-8680
Mailing Address - Fax:
Practice Address - Street 1:2670 COUNTY ROAD 57
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-6051
Practice Address - Country:US
Practice Address - Phone:308-313-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2073101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)