Provider Demographics
NPI:1750949228
Name:FORTSON, SANDRA ELLEN (MSW, LCSW)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:ELLEN
Last Name:FORTSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8665 CANDLEWOOD ST APT 8
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2335
Mailing Address - Country:US
Mailing Address - Phone:970-239-1599
Mailing Address - Fax:970-449-0429
Practice Address - Street 1:8665 CANDLEWOOD ST APT 8
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2335
Practice Address - Country:US
Practice Address - Phone:970-239-1599
Practice Address - Fax:970-449-0429
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1194661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical