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General NPI Number Information
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NPI Number | 1679787519
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Entity Type | Individual
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Provider Name | SANDRA GAY MATTSON LCSW, LISW-CP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 7621 LITTLE AVE STE 420
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City | CHARLOTTE
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State | NC
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Zip | 28226-8368
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Country | US
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Telephone | 704-541-5626
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Fax |
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Provider Business Mailing Address
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Address Line | 117 JIM CLARK RD
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City | PELION
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State | SC
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Zip | 29123
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Country | US
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Telephone | 803-894-9796
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9488
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License Number State | SC
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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 | SW7897
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License Number State | FL
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