Provider Demographics
NPI:1740141597
Name:ANDERSON, SANDRA MAE (LPCC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 LAKEVIEW AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3807
Mailing Address - Country:US
Mailing Address - Phone:651-500-8488
Mailing Address - Fax:
Practice Address - Street 1:2950 XENIUM LN N STE 130
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2623
Practice Address - Country:US
Practice Address - Phone:763-577-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306796101YA0400X
MN5278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)