Provider Demographics
NPI:1306374160
Name:SANFORD, RAZHEDATEQUILA EUNICETAGE (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:RAZHEDATEQUILA
Middle Name:EUNICETAGE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 WINGTHORN ROSE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8087
Mailing Address - Country:US
Mailing Address - Phone:704-772-5941
Mailing Address - Fax:
Practice Address - Street 1:848 WINGTHORN ROSE DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8087
Practice Address - Country:US
Practice Address - Phone:048-982-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0111373104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker