Provider Demographics
NPI:1760702708
Name:WILSON, SANDRA ELAINE (PHD,ACSW,LCSW)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ELAINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD,ACSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 YORK AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2750
Mailing Address - Country:US
Mailing Address - Phone:404-752-1400
Mailing Address - Fax:404-756-8749
Practice Address - Street 1:868 YORK AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2750
Practice Address - Country:US
Practice Address - Phone:404-752-1400
Practice Address - Fax:404-756-8749
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0015041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical