Provider Demographics
NPI:1851770580
Name:SANDRA PETRAKIS CHILDS LCSW LMFT LLC
Entity Type:Organization
Organization Name:SANDRA PETRAKIS CHILDS LCSW LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRAKIS CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LMFT
Authorized Official - Phone:770-458-8909
Mailing Address - Street 1:1540 PARK CREEK CV NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2146
Mailing Address - Country:US
Mailing Address - Phone:770-458-8909
Mailing Address - Fax:678-720-0993
Practice Address - Street 1:2900 CHAMBLEE TUCKER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4100
Practice Address - Country:US
Practice Address - Phone:770-458-8909
Practice Address - Fax:678-720-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW000536104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty