Provider Demographics
NPI:1730255175
Name:SANDERFORD, CARL PERRY (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:PERRY
Last Name:SANDERFORD
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 HIGHWAY 471
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-7511
Mailing Address - Country:US
Mailing Address - Phone:601-825-8087
Mailing Address - Fax:
Practice Address - Street 1:1578 HIGHWAY 471
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-7511
Practice Address - Country:US
Practice Address - Phone:601-825-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0323101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health