Healthcare Provider Details

I. General information

NPI: 1144834003
Provider Name (Legal Business Name): CHRISTOPHER DEWARD SANDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GURLEY ST
MARION SC
29571-4559
US

IV. Provider business mailing address

2958 FOXWORTH RD
MARION SC
29571-8247
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-8360
  • Fax:
Mailing address:
  • Phone: 919-622-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: