Provider Demographics
NPI:1427725878
Name:SANDERS, COURTNEY (LCSW-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 ROUTE 108 STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1990
Mailing Address - Country:US
Mailing Address - Phone:301-606-1812
Mailing Address - Fax:
Practice Address - Street 1:2402 PONDEROSA HILL RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:CO
Practice Address - Zip Code:80540-8432
Practice Address - Country:US
Practice Address - Phone:301-606-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099276061041C0700X
MD229821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical