Provider Demographics
NPI:1972737468
Name:WILCHER, SANDRA GALE (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:GALE
Last Name:WILCHER
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 1:2200 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2597
Mailing Address - Country:US
Mailing Address - Phone:229-244-1707
Mailing Address - Fax:229-244-1779
Practice Address - Street 1:2200 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2597
Practice Address - Country:US
Practice Address - Phone:229-244-1707
Practice Address - Fax:229-244-1779
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038651041C0700X
GA4068661041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool