Healthcare Provider Details

I. General information

NPI: 1568024578
Provider Name (Legal Business Name): DEIRDRA EILEEN SANDERS-BURNETT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 MEADOW LARK LN
WINTER HAVEN FL
33884-2543
US

IV. Provider business mailing address

PO BOX 1536
WINTER HAVEN FL
33882-1536
US

V. Phone/Fax

Practice location:
  • Phone: 863-224-3225
  • Fax: 863-324-3293
Mailing address:
  • Phone: 863-224-3225
  • Fax: 863-324-3293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: