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General NPI Number Information
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NPI Number | 1154613354
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Entity Type | Individual
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Provider Name | SARDIE ROCHELLE IZZARD LCAS-A, LCSW-A
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Gender | Female
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1102 KINDLEY ST
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City | GREENSBORO
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State | NC
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Zip | 27406-4213
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Country | US
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Telephone | 336-458-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 405 BATTLEGROUND AVE STE 205
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City | GREENSBORO
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State | NC
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Zip | 27401-2153
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Country | US
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Telephone | 336-550-4558
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Fax | 336-550-4561
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-22298
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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 | P015906
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License Number State | NC
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