Individual
CHARLES W SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, EDS,MA
Contact information
Practice address
5555 N TACOMA AVE, STE 204, INDIANAPOLIS, IN 46220-3512
(317) 257-7434
(317) 221-7733
Mailing address
5555 N TACOMA AVE, STE 204, INDIANAPOLIS, IN 46220-3512
(317) 257-7434
(317) 221-7733
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
34002652A
IN
1041C0700X
Clinical Social Worker
Primary
34002652A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100381890
—
IN
Enumeration date
12/09/2005
Last updated
04/30/2014
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