Provider Demographics
NPI:1952085557
Name:SANDERS, MELODY (RIC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2241
Mailing Address - Country:US
Mailing Address - Phone:757-285-0878
Mailing Address - Fax:
Practice Address - Street 1:5209 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2241
Practice Address - Country:US
Practice Address - Phone:757-285-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014205101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor