Provider Demographics
NPI:1043226483
Name:WILCOX, RODERICK MCLEOD (LCSW, MFT)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:MCLEOD
Last Name:WILCOX
Suffix:
Gender:M
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 WHISPERING PINES RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3562
Mailing Address - Country:US
Mailing Address - Phone:229-435-1729
Mailing Address - Fax:229-435-1720
Practice Address - Street 1:1216 WHISPERING PINES RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3562
Practice Address - Country:US
Practice Address - Phone:229-435-1729
Practice Address - Fax:229-435-1720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health