MEDICARE: SUZANNE WOOD SANFORD LPC

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	101YM0800X	Mental Health Counselor	0701003746	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84122M	OTHER	VA	SENTARA PROVIDER #
2	175433	OTHER	VA	ANTHEM PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770597718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE WOOD SANFORD LPC

Provider Business Mailing Address
First Line	:	PO BOX 433
Second Line	:
City	:	CHATHAM
State	:	VA
Zip	:	24531-0433
Country	:	US
Telephone Number	:	434-432-8602
Fax Number	:	434-432-8603

Provider Business Practice Location Address
First Line	:	25 REID STREET
Second Line	:
City	:	CHATHAM
State	:	VA
Zip	:	24531
Country	:	US
Telephone Number	:	434-432-8602
Fax Number	:	434-432-8603

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	06/03/2011

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Directions to “ SUZANNE WOOD SANFORD LPC” Practice Location

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