Provider Demographics
NPI:1194155887
Name:SANDIFER, MARVIN MATHIAS (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:MATHIAS
Last Name:SANDIFER
Suffix:
Gender:M
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13890
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3890
Mailing Address - Country:US
Mailing Address - Phone:336-621-3381
Mailing Address - Fax:336-621-7513
Practice Address - Street 1:810 WARREN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-2340
Practice Address - Country:US
Practice Address - Phone:336-517-3770
Practice Address - Fax:336-517-3783
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0073171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical