Individual
GWANA SANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., M.A., RAD-I
Contact information
Practice address
1341 N ESCONDIDO BLVD, ESCONDIDO, CA 92026-2507
(760) 208-2070
Mailing address
1341 N ESCONDIDO BLVD, ESCONDIDO, CA 92026-2507
(760) 208-2070
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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