Individual
MR. TIMOTHY PATRICK SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LASAC
Contact information
Practice address
702 W HILLSIDE AVE, PRESCOTT, AZ 86301-1913
(928) 778-5907
Mailing address
702 W HILLSIDE AVE, PRESCOTT, AZ 86301-1913
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15345
AZ
Other
Enumeration date
06/08/2020
Last updated
07/01/2020
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