Provider Demographics
NPI:1255072427
Name:SANFORD, KERA (LMSW)
Entity type:Individual
Prefix:
First Name:KERA
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KERA
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:14889 RUE RD
Mailing Address - Street 2:
Mailing Address - City:COKER
Mailing Address - State:AL
Mailing Address - Zip Code:35452-3872
Mailing Address - Country:US
Mailing Address - Phone:517-316-5651
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD STE 110
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3751
Practice Address - Country:US
Practice Address - Phone:586-580-2975
Practice Address - Fax:586-580-2954
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-04
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255072427Medicaid