Provider Demographics
NPI:1154613354
Name:IZZARD, SARDIE ROCHELLE (LCAS-A, LCSW-A)
Entity type:Individual
Prefix:
First Name:SARDIE
Middle Name:ROCHELLE
Last Name:IZZARD
Suffix:
Gender:F
Credentials:LCAS-A, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BATTLEGROUND AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2153
Mailing Address - Country:US
Mailing Address - Phone:336-550-4558
Mailing Address - Fax:336-550-4561
Practice Address - Street 1:1102 KINDLEY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4213
Practice Address - Country:US
Practice Address - Phone:336-458-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCLCAS-22298101YA0400X
NCP0159061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical