Healthcare Provider Details

I. General information

NPI: 1194042630
Provider Name (Legal Business Name): CHRISTIAN T SANDERS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10632 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3273
US

IV. Provider business mailing address

10632 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-3273
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8066
  • Fax: 410-740-8068
Mailing address:
  • Phone: 410-740-8066
  • Fax: 410-740-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2075
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: