Provider Demographics
NPI:1952966459
Name:SANDERS, CHRISTINA NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:N
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3745 CHEROKEE ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6733
Mailing Address - Country:US
Mailing Address - Phone:770-499-0140
Mailing Address - Fax:770-499-0147
Practice Address - Street 1:3745 CHEROKEE ST NW STE 606
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6785
Practice Address - Country:US
Practice Address - Phone:770-499-0140
Practice Address - Fax:770-499-0147
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional