Provider Demographics
NPI:1770597718
Name:SANFORD, SUZANNE WOOD (LPC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:WOOD
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-0433
Mailing Address - Country:US
Mailing Address - Phone:434-432-8602
Mailing Address - Fax:434-432-8603
Practice Address - Street 1:25 REID STREET
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531
Practice Address - Country:US
Practice Address - Phone:434-432-8602
Practice Address - Fax:434-432-8603
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA84122MOtherSENTARA PROVIDER #
VA175433OtherANTHEM PROVIDER #
VA010135702Medicaid