Provider Demographics
NPI:1164508875
Name:EMPACT-SPC
Entity Type:Organization
Organization Name:EMPACT-SPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MC, NCC, LISAC, LPC
Authorized Official - Phone:480-784-1514
Mailing Address - Street 1:6629 N 90TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2043
Mailing Address - Country:US
Mailing Address - Phone:623-872-7468
Mailing Address - Fax:
Practice Address - Street 1:4425 W OLIVE AVE
Practice Address - Street 2:SUITE 194
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3843
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12392251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health