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General NPI Number Information
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NPI Number | 1972292902
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Entity Type | Individual
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Provider Name | YVONNE PETERSON SANDERS
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Gender | Female
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 3190 ASHLY BROOKE DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-4528
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Country | US
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Telephone | 219-218-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 3190 ASHLY BROOKE DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-4528
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Country | US
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Telephone | 219-218-3737
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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 | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | 37844001
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License Number State |
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