Healthcare Provider Details

I. General information

NPI: 1962372573
Provider Name (Legal Business Name): TIERRA R OGAWA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5043 FRANKFORD AVE
PHILADELPHIA PA
19124-2644
US

IV. Provider business mailing address

5043 FRANKFORD AVE
PHILADELPHIA PA
19124-2644
US

V. Phone/Fax

Practice location:
  • Phone: 215-744-4343
  • Fax: 215-744-8731
Mailing address:
  • Phone: 215-744-4343
  • Fax: 215-744-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: