Provider Demographics
NPI:1770353922
Name:WADDLE, SAVANNA (LMSW)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:WADDLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-3313
Mailing Address - Country:US
Mailing Address - Phone:912-231-5221
Mailing Address - Fax:
Practice Address - Street 1:1104 E 37TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3313
Practice Address - Country:US
Practice Address - Phone:912-231-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15371104100000X
GAMSW010967104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker