Healthcare Provider Details

I. General information

NPI: 1215409057
Provider Name (Legal Business Name): STEPHANIE L. SANDERS, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 WEATHERS PL STE 102
SAN DIEGO CA
92121-3911
US

IV. Provider business mailing address

PO BOX 759
POWAY CA
92074-0759
US

V. Phone/Fax

Practice location:
  • Phone: 858-956-5545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE L SANDERS
Title or Position: OWNER
Credential: LCSW
Phone: 619-363-5228