Provider Demographics
NPI:1235468620
Name:PIERCE, SANDRA LYNN (LCSW-C, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LYNN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LCSW-C, LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C, LCSW
Mailing Address - Street 1:1406B CRAIN HWY S
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4099
Mailing Address - Country:US
Mailing Address - Phone:410-768-6088
Mailing Address - Fax:410-768-6444
Practice Address - Street 1:1406B CRAIN HWY S
Practice Address - Street 2:SUITE 206
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4099
Practice Address - Country:US
Practice Address - Phone:410-768-6088
Practice Address - Fax:410-768-6444
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155021041C0700X
PACW0173211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027809200Medicaid