Basic Information
| Provider Information | |||||||||
| NPI: | 1730563586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRING | ||||||||
| FirstName: | SONJA | ||||||||
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| Credential: | LCASA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S FAYETTEVILLE ST | ||||||||
| Address2: | |||||||||
| City: | SALEMBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283857915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108244171 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2003 GODWIN AVE STE B | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106711111 | ||||||||
| FaxNumber: | 9106714454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2015 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2320 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.