Provider Demographics
NPI:1356537559
Name:DAVIDSON, SANDY M (LISW-CP)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N GOOSE CREEK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2960
Mailing Address - Country:US
Mailing Address - Phone:848-408-4732
Mailing Address - Fax:866-708-1623
Practice Address - Street 1:119 N GOOSE CREEK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2960
Practice Address - Country:US
Practice Address - Phone:848-408-4732
Practice Address - Fax:866-708-1623
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical