Basic Information
| Provider Information | |||||||||
| NPI: | 1275860835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | AUGUSTINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW, LMSW, LADAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1346 | ||||||||
| Address2: | |||||||||
| City: | MANCOS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813281346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705709933 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 691 E EMPIRE ST | ||||||||
| Address2: | |||||||||
| City: | CORTEZ | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813212802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705657946 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 99-07-18 | OR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 0125511 | NM | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 13004 | AZ | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CSW.09923921 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.