Healthcare Provider Details

I. General information

NPI: 1467228387
Provider Name (Legal Business Name): THERESE MARIE SANDERSON LPC, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESE BEGAN LPC

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 STONEWOOD DR STE 110
WEXFORD PA
15090-8398
US

IV. Provider business mailing address

100 RABOLD DR
WEXFORD PA
15090-8645
US

V. Phone/Fax

Practice location:
  • Phone: 412-923-0677
  • Fax:
Mailing address:
  • Phone: 412-495-2895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006871
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361004435
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: