Provider Demographics
NPI:1285867630
Name:SANDERS, CYNTHIA SUSANNE (LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUSANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1806
Mailing Address - Country:US
Mailing Address - Phone:706-213-2048
Mailing Address - Fax:
Practice Address - Street 1:50 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1806
Practice Address - Country:US
Practice Address - Phone:706-213-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005467101YP2500X
SC4695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional