Provider Demographics
NPI:1235556226
Name:SANFORD, MORGAN (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:M
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:2826 AMNICOLA HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-3605
Mailing Address - Country:US
Mailing Address - Phone:501-574-3053
Mailing Address - Fax:
Practice Address - Street 1:1961 NORTHPOINT BLVD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4556
Practice Address - Country:US
Practice Address - Phone:615-309-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000975103K00000X
SC0-13-5620103K00000X
TN780103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst