Individual
CLYDE WILLIAM SANDFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
169 DEMPSEY AVE STE 3, JACKSON, GA 30233-2019
(401) 889-4673
Mailing address
PO BOX 703, JACKSON, GA 30233-0014
(603) 801-9392
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC011574
GA
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC011574
GA
101YM0800X
Mental Health Counselor
LPC011574
GA
101YP1600X
Pastoral Counselor
LPC011574
GA
101YP2500X
Professional Counselor
Primary
LPC011574
GA
106H00000X
Marriage & Family Therapist
LPC011574
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81263595
—
NH
Enumeration date
07/06/2009
Last updated
02/28/2024
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