Basic Information
Provider Information
NPI: 1033557558
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANFORD
FirstName: APRIL
MiddleName: INEZ
NamePrefix:  
NameSuffix:  
Credential: MA, LLMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2432 CROOKS RD
Address2: APT 38
City: TROY
State: MI
PostalCode: 480845336
CountryCode: US
TelephoneNumber: 5175051005
FaxNumber:  
Practice Location
Address1: 79 W ALEXANDRINE ST
Address2:  
City: DETROIT
State: MI
PostalCode: 482012015
CountryCode: US
TelephoneNumber: 1312620955
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/06/2013
LastUpdateDate: 06/06/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X6801092992MIY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


Home