Provider Demographics
NPI:1942866702
Name:WIECK, SARAH KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:KATHLEEN
Last Name:WIECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 PERCY WARNER BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-4105
Mailing Address - Country:US
Mailing Address - Phone:615-419-1180
Mailing Address - Fax:
Practice Address - Street 1:2300 21ST AVE S STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4927
Practice Address - Country:US
Practice Address - Phone:615-419-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000045141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical