Doctor Name: | KIMBERLY SANDERSON |
NPI Number: | 1104203256 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH13356 |
Business Practice Address: | 1700 Education Ave Punta Gorda, FL - 339506222 |
Business Phone Number: | 9415398300 |
Business Fax Number: | 9416396831 |
Mailing Address: | 1700 Education Ave, PUNTA GORDA |
State: | FL |
Postal Code: | 339506222 |
Phone Number: | 9415398300 |
Fax Number: | 9416396831 |
NPI Enumeration Date: | 04/28/2015 |
NPI Last Update Date: | 04/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH13356 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |