Healthcare Provider Details

I. General information

NPI: 1780058115
Provider Name (Legal Business Name): MICHELLE SANDERSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 MCLEOD RD NE
ALBUQUERQUE NM
87109-2455
US

IV. Provider business mailing address

7900 DRAGOON RD NW
ALBUQUERQUE NM
87114-4475
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-1670
  • Fax:
Mailing address:
  • Phone: 505-228-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB20230886
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: