MEDICARE: LILLIAN A SANDERS LISW-CP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	16104	SC

General Provider Information

NPI Number	:	1316627243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN A SANDERS LISW-CP

Provider Business Mailing Address
First Line	:	3210 FORK SHOALS RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6813
Country	:	US
Telephone Number	:	864-270-6186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 FORK SHOALS RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6813
Country	:	US
Telephone Number	:	864-270-6186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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