MEDICARE: SANDRA JANE LOYDPIERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	COO2504	NC

General Provider Information

NPI Number	:	1750543468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA JANE LOYDPIERSON LCSW

Provider Business Mailing Address
First Line	:	3214 STONEYBROOK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3154
Country	:	US
Telephone Number	:	704-965-0603
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 STONEYBROOK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3154
Country	:	US
Telephone Number	:	704-965-0603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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