Healthcare Provider Details

I. General information

NPI: 1265368963
Provider Name (Legal Business Name): ASHLYN SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13113 LAKEMORE DR
CHARLOTTE NC
28278-0182
US

IV. Provider business mailing address

409 W 26TH ST # 11202
CHARLOTTE NC
28206-2621
US

V. Phone/Fax

Practice location:
  • Phone: 704-629-8240
  • Fax:
Mailing address:
  • Phone: 980-213-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: