Provider Demographics
NPI:1699299586
Name:SANDERS, RENITA J (LCPC)
Entity type:Individual
Prefix:
First Name:RENITA
Middle Name:J
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 W TAYLOR ST # 238
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4336
Mailing Address - Country:US
Mailing Address - Phone:630-427-4144
Mailing Address - Fax:
Practice Address - Street 1:1074 W TAYLOR ST # 238
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4336
Practice Address - Country:US
Practice Address - Phone:630-427-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014460101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional