Clyde William Sandford, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC011574 Issued in GA

Practice address

169 Dempsey Ave Ste 3
Jackson, GA 30233-2019

Phone

(401) 889-4673

NPI assigned

Jul 6, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 2, 2024 through Apr 2, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eagle'S Landing Christian Counseling Center, Inc.

  • Professional Counselor
  • McDonough, GA
  • NPI 1093955205
  NPD
• Monadnock Family Services

  • Community/Behavioral Health Agency
  • Keene, NH
  • NPI 1649331224
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1316176860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 703",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302330014",
            "telephone_number": "603-801-9392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 DEMPSEY AVE STE 3",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302332019",
            "telephone_number": "401-889-4673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 Vose Farm Rd",
            "address_2": "suite 120",
            "address_purpose": "LOCATION",
            "city": "Peterborough",
            "state": "NH",
            "postal_code": "034582154",
            "country_code": "US",
            "telephone_number": "603-924-7236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1944 Brannan Rd",
            "address_purpose": "LOCATION",
            "city": "McDonough",
            "state": "GA",
            "postal_code": "302534310",
            "country_code": "US",
            "telephone_number": "678-289-6981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDFORD",
        "first_name": "CLYDE",
        "middle_name": "WILLIAM",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-06",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "LPC011574",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "LPC011574",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "LPC011574",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC011574",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "GA",
            "license": "LPC011574",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC011574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81263595",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Jackson, GA
• Providers in Jackson, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.