MEDICARE: OASIS THERAPEUTIC SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	106H00000X	Marriage & Family Therapist
3	1041C0700X	Clinical Social Worker
4	101YM0800X	Mental Health Counselor
5	101YA0400X	Addiction (Substance Use Disorder) Counselor
6	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952032898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS THERAPEUTIC SERVICES PLLC

Provider Business Mailing Address
First Line	:	3481 BEAR DEN DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-0009
Country	:	US
Telephone Number	:	704-689-1577
Fax Number	:

Provider Business Practice Location Address
First Line	:	3481 BEAR DEN DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-0009
Country	:	US
Telephone Number	:	704-689-1577
Fax Number	:	980-422-0383

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. RAZHEDATEQUILA EUNICETAGE SANFORD
Credential	:	LCSW LCAS, CSI
Telephone Number	:	704-689-1577

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	02/04/2026

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