MEDICARE: JOYCE ANN SANDERS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102033	VA
2	101YP2500X	Professional Counselor	0704006290	VA

General Provider Information

NPI Number	:	1710515853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE ANN SANDERS

Provider Business Mailing Address
First Line	:	6718 HEDGES RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23224-2557
Country	:	US
Telephone Number	:	804-908-2160
Fax Number	:

Provider Business Practice Location Address
First Line	:	6718 HEDGES RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23224-2557
Country	:	US
Telephone Number	:	804-908-2160
Fax Number	:

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	12/09/2022

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