Provider Demographics
NPI:1336352897
Name:SAMPSON, WENDY (LCSW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 ALFRED STREET
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4244
Mailing Address - Country:US
Mailing Address - Phone:803-643-7073
Mailing Address - Fax:
Practice Address - Street 1:886 ALFRED STREET
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4244
Practice Address - Country:US
Practice Address - Phone:803-643-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0028441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical