Provider Demographics
NPI:1689416992
Name:SANDERS, ANNETTE SUSANNE (ALC)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:SUSANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4300
Mailing Address - Country:US
Mailing Address - Phone:706-566-6458
Mailing Address - Fax:
Practice Address - Street 1:105 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4300
Practice Address - Country:US
Practice Address - Phone:706-566-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty