Healthcare Provider Details

I. General information

NPI: 1194877043
Provider Name (Legal Business Name): ANGELA M SANDERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E ASCENSION COMPLEX BLVD
GONZALES LA
70737-4265
US

IV. Provider business mailing address

PO BOX 1725
GONZALES LA
70707-1725
US

V. Phone/Fax

Practice location:
  • Phone: 225-621-5770
  • Fax: 225-644-5168
Mailing address:
  • Phone: 225-621-5770
  • Fax: 225-644-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9401
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: