Provider Demographics
NPI:1841563988
Name:SANDERS, ROBERT L (LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 WOODCHUCK WAY
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-7948
Mailing Address - Country:US
Mailing Address - Phone:706-284-2382
Mailing Address - Fax:
Practice Address - Street 1:1953 WOODCHUCK WAY
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-7948
Practice Address - Country:US
Practice Address - Phone:706-284-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006452172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker