Healthcare Provider Details

I. General information

NPI: 1346903077
Provider Name (Legal Business Name): SANDRA DAWN WOHALI LCSW, MAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA WILBANKS

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 MARIA LN STE 300
WALNUT CREEK CA
94596-5314
US

IV. Provider business mailing address

1381 ROSAL LN
CONCORD CA
94521-2635
US

V. Phone/Fax

Practice location:
  • Phone: 925-291-5598
  • Fax: 925-309-6098
Mailing address:
  • Phone: 925-383-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122530
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102307
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: