Provider Demographics
NPI:1417497348
Name:POVOA, SANDRA H (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:H
Last Name:POVOA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 39462
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1026
Mailing Address - Country:US
Mailing Address - Phone:704-576-5996
Mailing Address - Fax:
Practice Address - Street 1:8832 BLAKENEY PROFESSIONAL DR STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6717
Practice Address - Country:US
Practice Address - Phone:704-576-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical