Healthcare Provider Details

I. General information

NPI: 1952787814
Provider Name (Legal Business Name): SANDRA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/13/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 LYNX LN STE 285
COLUMBIA MD
21044-2483
US

IV. Provider business mailing address

1200 FIRST STREET NE
WASHINGTON DC
20002
US

V. Phone/Fax

Practice location:
  • Phone: 240-786-2329
  • Fax:
Mailing address:
  • Phone: 240-786-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-20319
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079827
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106711
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904018653
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50079827
License Number StateDC
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21660
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: