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General NPI Number Information
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NPI Number | 1679802870
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Entity Type | Individual
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Provider Name | DEIDREA SANDERS M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 2127 MAPLEWOOD AVE
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City | SAGINAW
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State | MI
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Zip | 48601-3604
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Country | US
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Telephone | 989-327-7565
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Fax |
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Provider Business Mailing Address
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Address Line | 2127 MAPLEWOOD AVE
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City | SAGINAW
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State | MI
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Zip | 48601-3604
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Country | US
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Telephone | 989-755-4297
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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