Provider Demographics
NPI:1033688429
Name:RETTIS, SANDRA FRANCIS (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:FRANCIS
Last Name:RETTIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 UNION ST S STE 206
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1004
Mailing Address - Country:US
Mailing Address - Phone:704-918-9741
Mailing Address - Fax:
Practice Address - Street 1:11 UNION ST S STE 206
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1004
Practice Address - Country:US
Practice Address - Phone:704-918-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0123661041C0700X
NCC0135251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical