Healthcare Provider Details

I. General information

NPI: 1023388618
Provider Name (Legal Business Name): SANDRA JOYCE WORTHINGTON L.P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 18TH ST SE
HICKORY NC
28602-1364
US

IV. Provider business mailing address

255 18TH ST SE
HICKORY NC
28602-1364
US

V. Phone/Fax

Practice location:
  • Phone: 828-327-6633
  • Fax:
Mailing address:
  • Phone: 828-327-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1473
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1473
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1473
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1473
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1473
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: