Provider Demographics
NPI:1881736049
Name:SNYDER, SANDRA MAYFIELD JR (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MAYFIELD
Last Name:SNYDER
Suffix:JR
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 HAWTHORN LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1588
Mailing Address - Country:US
Mailing Address - Phone:770-979-5033
Mailing Address - Fax:
Practice Address - Street 1:1126 HAWTHORN LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1588
Practice Address - Country:US
Practice Address - Phone:770-979-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical