MEDICARE: EMILY SANDERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701006782	VA

General Provider Information

NPI Number	:	1831648559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SANDERS

Provider Business Mailing Address
First Line	:	7320 HERITAGE VILLAGE PLZ
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	571-248-1036
Fax Number	:

Provider Business Practice Location Address
First Line	:	7320 HERITAGE VILLAGE PLZ
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	571-248-1036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	09/22/2016

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