Provider Demographics
NPI:1053776377
Name:SANFORD, HIAWATHA FRENCHSHELLA (LCSW)
Entity type:Individual
Prefix:MS
First Name:HIAWATHA
Middle Name:FRENCHSHELLA
Last Name:SANFORD
Suffix:
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 1:740A WELLS EXT.
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38620
Mailing Address - Country:US
Mailing Address - Phone:662-934-0332
Mailing Address - Fax:
Practice Address - Street 1:740A WELLS EXT
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:MS
Practice Address - Zip Code:38620-9639
Practice Address - Country:US
Practice Address - Phone:662-934-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW62851041C0700X
MSC47891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical