Provider Demographics
NPI:1790576940
Name:SANFORD, MOLLY (LLMSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-5709
Mailing Address - Country:US
Mailing Address - Phone:989-513-9923
Mailing Address - Fax:
Practice Address - Street 1:4467 CASCADE RD SE STE 4480
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3776
Practice Address - Country:US
Practice Address - Phone:616-481-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851120000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health