Provider Demographics
NPI:1912361312
Name:MACHADO, WENDY (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MACHADO
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 1:3629 WOOD POINT WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507
Mailing Address - Country:US
Mailing Address - Phone:678-207-2955
Mailing Address - Fax:
Practice Address - Street 1:915 INTERSTATE RIDGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7076
Practice Address - Country:US
Practice Address - Phone:678-207-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical