Provider Demographics
NPI:1437582467
Name:WILCOX, SANDRA GAIL (LPC, MA, MDIV)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:GAIL
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LPC, MA, MDIV
Other - Prefix:MS
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:5505 MAPLELEAF DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2610
Mailing Address - Country:US
Mailing Address - Phone:512-585-6457
Mailing Address - Fax:
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE C4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-585-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66947OtherLICENSED PROFESSIONAL COUNSELOR