Healthcare Provider Details

I. General information

NPI: 1225946882
Provider Name (Legal Business Name): NICOLE SANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CONCOURSE BLVD
GLEN ALLEN VA
23059-5643
US

IV. Provider business mailing address

8239 WEATHERED OAK LN
MECHANICSVILLE VA
23111-4631
US

V. Phone/Fax

Practice location:
  • Phone: 804-543-4542
  • Fax:
Mailing address:
  • Phone: 804-332-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: