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General NPI Number Information
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NPI Number | 1366304917
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Entity Type | Individual
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Provider Name | MIA SANDERS
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Gender |
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 26 WESMARK CT
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City | SUMTER
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State | SC
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Zip | 29150-1996
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Country | US
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Telephone | 803-883-4981
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 DAIS RD
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City | REMBERT
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State | SC
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Zip | 29128-9312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10754
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License Number State | SC
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