Provider Demographics
NPI:1518366137
Name:SANFORD, LOLA (LPCA, MFTA)
Entity Type:Individual
Prefix:MS
First Name:LOLA
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LPCA, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 GLAMORGAN LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-0643
Mailing Address - Country:US
Mailing Address - Phone:336-880-5247
Mailing Address - Fax:
Practice Address - Street 1:4232 SHOPTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3016
Practice Address - Country:US
Practice Address - Phone:336-880-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist