Provider Demographics
NPI:1760052948
Name:SANDERSON, STELLA GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:GRACE
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 AERO DR. STE 115
Mailing Address - Street 2:#1010
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1743
Mailing Address - Country:US
Mailing Address - Phone:619-887-4474
Mailing Address - Fax:
Practice Address - Street 1:9655 GRANITE RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2676
Practice Address - Country:US
Practice Address - Phone:619-887-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1219201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical