Basic Information
| Provider Information | |||||||||
| NPI: | 1558416222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SONEN | ||||||||
| FirstName: | SOPHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 M. GEORGIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105483716 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CENTER 4 CLEAN START | ||||||||
| Address2: | 1001 LAKE STREET | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107423460 | ||||||||
| FaxNumber: | 4107425810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCA295 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.