Provider Demographics
NPI:1447641758
Name:SANDERSON, STEPHANIE (LCMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 SADDLETREE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-9301
Mailing Address - Country:US
Mailing Address - Phone:910-384-4147
Mailing Address - Fax:
Practice Address - Street 1:2200 CLYBOURN CHURCH RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-9356
Practice Address - Country:US
Practice Address - Phone:910-739-9160
Practice Address - Fax:910-739-9155
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20682101YA0400X
NCLCAS - A 20682101YA0400X
NCA10597101YP2500X
NC10597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)