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General NPI Number Information
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NPI Number | 1083703318
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Entity Type | Individual
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Provider Name | KASANDRA CAROL ANSPACH-SPORTSMAN MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 901 ARSENAL AVE STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5478
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Country | US
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Telephone | 910-323-3368
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Fax | 910-486-7000
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Provider Business Mailing Address
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Address Line | 114 SHADSFORD BLVD
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1221
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Country | US
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Telephone | 910-867-9495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | COO5657
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P002867
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C00567
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License Number State | NC
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