Provider Demographics
NPI:1083703318
Name:ANSPACH-SPORTSMAN, KASANDRA CAROL (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KASANDRA
Middle Name:CAROL
Last Name:ANSPACH-SPORTSMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SHADSFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1221
Mailing Address - Country:US
Mailing Address - Phone:910-867-9495
Mailing Address - Fax:
Practice Address - Street 1:901 ARSENAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5478
Practice Address - Country:US
Practice Address - Phone:910-323-3368
Practice Address - Fax:910-486-7000
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COO5657104100000X
NCP0028671041C0700X
NCC005671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker