Provider Demographics
NPI:1821706474
Name:HETRICK, SALLY KATHERINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:KATHERINE
Last Name:HETRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:KATHERINE
Other - Last Name:WESCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:903 N 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4621
Mailing Address - Country:US
Mailing Address - Phone:850-424-8295
Mailing Address - Fax:850-424-8296
Practice Address - Street 1:903 N 60TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-4621
Practice Address - Country:US
Practice Address - Phone:850-424-8295
Practice Address - Fax:850-424-8296
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4529C1041C0700X
FLSW242791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical