Basic Information
Provider Information
NPI: 1356978365
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAJMI
FirstName: SONILA
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 645 S ROGERS ST
Address2:  
City: BLOOMINGTON
State: IN
PostalCode: 474032353
CountryCode: US
TelephoneNumber: 8123391691
FaxNumber: 8123398109
Practice Location
Address1: 645 S ROGERS ST
Address2:  
City: BLOOMINGTON
State: IN
PostalCode: 474032353
CountryCode: US
TelephoneNumber: 8123391691
FaxNumber: 8123398109
Other Information
ProviderEnumerationDate: 03/27/2020
LastUpdateDate: 03/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X39003724AINY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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