Provider Demographics
NPI:1740331990
Name:SEDGWICK, CHARLALEE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLALEE
Middle Name:
Last Name:SEDGWICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2814
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-2814
Mailing Address - Country:US
Mailing Address - Phone:912-238-5500
Mailing Address - Fax:912-786-4067
Practice Address - Street 1:109 W BOLTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6371
Practice Address - Country:US
Practice Address - Phone:912-238-5500
Practice Address - Fax:912-786-4067
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDDDMedicare ID - Type UnspecifiedPSYCHOLOGY