Provider Demographics
NPI:1518013473
Name:PETRAKIS-CHILDS, SANDRA (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PETRAKIS-CHILDS
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4938
Mailing Address - Country:US
Mailing Address - Phone:770-458-8909
Mailing Address - Fax:
Practice Address - Street 1:3990 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4938
Practice Address - Country:US
Practice Address - Phone:770-458-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5361041C0700X
GA337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist