Amy Lynn Sanderson, MA, LCMHC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

11665 Issued in NC

Practice address

1118 Sam Newell Rd Ste D4
Matthews, NC 28105-5162

Phone

(248) 396-8810

Fax

(704) 919-5155

NPI assigned

Dec 18, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 27, 2024 through Feb 27, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindful Movements, PLLC

  • Community/Behavioral Health Agency
  • Matthews, NC
  • NPI 1205392099

  Mental Health

  NPD Authorized official
• Amy Sanderson

  • Community/Behavioral Health Agency
  • Waxhaw, NC
  • NPI 1497126049
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1386009389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 DEER BRUSH LN",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736307",
            "telephone_number": "248-396-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 SAM NEWELL RD STE D4",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055162",
            "telephone_number": "248-396-8810",
            "fax_number": "704-919-5155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Deer Brush Ln",
            "address_purpose": "LOCATION",
            "city": "Waxhaw",
            "state": "NC",
            "postal_code": "281736307",
            "country_code": "US",
            "telephone_number": "248-396-8810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "MA, LCMHC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-18",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "11665",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "11665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Salomon
• Erica O Salter, LCAS
• Sam'S Club Optical
• Sams East Inc
• Sana Counseling LLC
• Mollie Sandler, LCSWA
• Sanear Corporation
• Sanear Corporation
• Eliza N Sangmuah, MD
• Amina Santali, NP

• Professional Counselor in Matthews, NC
• Providers in Matthews, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.