Healthcare Provider Details

I. General information

NPI: 1295130144
Provider Name (Legal Business Name): BRENDA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA LEE SANDERS LMSW

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 MACK AVE
DETROIT MI
48207-2302
US

IV. Provider business mailing address

921 HOWARD ST
DEARBORN MI
48124-2210
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax:
Mailing address:
  • Phone: 313-274-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801096471
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: