Provider Demographics
NPI:1306086723
Name:SANDERSON, ERIC A (LCSW)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:A
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 N ROBINSON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7425
Mailing Address - Country:US
Mailing Address - Phone:405-633-0155
Mailing Address - Fax:405-721-1838
Practice Address - Street 1:6003 N ROBINSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7425
Practice Address - Country:US
Practice Address - Phone:405-633-0155
Practice Address - Fax:405-721-1838
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical