Provider Demographics
NPI:1952911919
Name:SANDERS, ALICE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11940 BRICKSOME AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2594
Mailing Address - Country:US
Mailing Address - Phone:225-250-5829
Mailing Address - Fax:225-250-5879
Practice Address - Street 1:11940 BRICKSOME AVE STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2594
Practice Address - Country:US
Practice Address - Phone:225-250-5829
Practice Address - Fax:225-250-5879
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAS722370171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator