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CLYDE WILLIAM SANDFORD LPC
NPI 1316176860
Counselor - Professional in Jackson, GA

Active since July 06, 2009Opted out of Medicare · through Apr 2, 2028
169 DEMPSEY AVE STE 3, JACKSON, GA 30233(401) 889-4673 Get Directions Write a Review

NPPES record last updated: February 28, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Clyde William Sandford Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLYDE WILLIAM SANDFORD LPC (NPI 1316176860) is an individual professional provider in Jackson, Georgia, licensed in Georgia (LPC011574) and active in the NPI registry since July 2009. He has opted out of Medicare through April 2, 2028.

NPPES Registry Identity

NPI1316176860
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameCLYDE WILLIAM SANDFORDCredential: LPC
Location Address169 DEMPSEY AVE STE 3Jackson, GA 30233-2019
Mailing AddressPo Box 703Jackson, GA 30233-0014 · (603) 801-9392
Phone(401) 889-4673
Sole ProprietorYes
Enumeration DateJuly 6, 2009
Last NPPES UpdateFebruary 28, 2024
NPPES CertifiedFebruary 28, 2024
✔ NPI 1316176860 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in GA · LPC011574
Also ListedCounselorTaxonomy 101Y00000X · License LPC011574 (GA)
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License LPC011574 (GA)
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License LPC011574 (GA)
Also ListedCounselor · PastoralTaxonomy 101YP1600X · License LPC011574 (GA)
Also ListedMarriage & Family TherapistTaxonomy 106H00000X · License LPC011574 (GA)
169 DEMPSEY AVE STE 3, Jackson, GA 30233
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Other Identifiers 1

Medicaid81263595NH

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Clyde William Sandford Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 2, 2024 through April 2, 2028.

Opt-Out Effective DateApril 2, 2024
Opt-Out In Effect ThroughApril 2, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clyde Sandford's NPI number?

The NPI number for Clyde Sandford is 1316176860. It was assigned to this individual provider in the NPPES registry on July 6, 2009.

Where is Clyde Sandford located?

Clyde Sandford practices at 169 Dempsey Ave Ste 3, Jackson, GA 30233. The listed phone number is (401) 889-4673.

What is Clyde Sandford's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Clyde Sandford enrolled in Medicare?

No. Clyde Sandford has opted out of Medicare through April 2, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Clyde Sandford was last updated on February 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.