Basic Information
| Provider Information | |||||||||
| NPI: | 1730292947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDERLIN | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1443 THOMPSON CIR | ||||||||
| Address2: | |||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983279722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535828440 | ||||||||
| FaxNumber: | 2535894136 | ||||||||
| Practice Location | |||||||||
| Address1: | VA PUGET SOUND HCS | ||||||||
| Address2: | AMERICAN LAKE VA, BLDG. 61C | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535828440 | ||||||||
| FaxNumber: | 2535894136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | NOT LICENSED | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.