Healthcare Provider Details

I. General information

NPI: 1932379898
Provider Name (Legal Business Name): MICHELLE E. SANDERS LCSW, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

BLDG. 9920B, MADIGAN ANNEX
JBLM WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-6442
  • Fax:
Mailing address:
  • Phone: 253-968-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10012
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23424
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: