Provider Demographics
NPI:1366101107
Name:SANDERS, MICHELLE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:RICHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 S SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1360
Mailing Address - Country:US
Mailing Address - Phone:812-288-4688
Mailing Address - Fax:812-610-8333
Practice Address - Street 1:225 S SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1360
Practice Address - Country:US
Practice Address - Phone:812-288-4688
Practice Address - Fax:812-610-8333
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009530A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical