Healthcare Provider Details

I. General information

NPI: 1386317543
Provider Name (Legal Business Name): ALLISON MAUREEN SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 BATTLEGROUND AVE STE 220
GREENSBORO NC
27410-2490
US

IV. Provider business mailing address

1000 JEFFERSON ST STE 2C
LYNCHBURG VA
24504-1724
US

V. Phone/Fax

Practice location:
  • Phone: 855-284-7483
  • Fax: 617-807-0958
Mailing address:
  • Phone: 855-284-7483
  • Fax: 617-807-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12302
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: