Provider Demographics
NPI:1043513690
Name:SANDIFER, MELBA B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:B
Last Name:SANDIFER
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 1:708 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-2500
Mailing Address - Country:US
Mailing Address - Phone:318-428-9000
Mailing Address - Fax:318-428-9759
Practice Address - Street 1:708 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-2500
Practice Address - Country:US
Practice Address - Phone:318-428-9000
Practice Address - Fax:318-428-9759
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical