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General NPI Number Information
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NPI Number | 1467905943
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Entity Type | Individual
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Provider Name | MICHAEL CARROLL SANDERS LPC
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Gender | Male
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Dates
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Enumeration Date | 08/01/2016
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Last Update Date | 08/01/2016
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Provider Practice Location Address
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Address Line | 2601 N HULLEN ST STE 136
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City | METAIRIE
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State | LA
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Zip | 70002-5900
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Country | US
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Telephone | 504-341-4869
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Fax | 504-341-6548
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Provider Business Mailing Address
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Address Line | 2717 PRITCHARD RD
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City | MARRERO
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State | LA
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Zip | 70072-6007
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Country | US
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Telephone | 504-341-4869
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Fax | 504-341-6548
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4391
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License Number State | LA
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