Provider Demographics
NPI:1003057969
Name:BOHANNON-THACKER, SONJA JO (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SONJA
Middle Name:JO
Last Name:BOHANNON-THACKER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MOORESVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-0304
Mailing Address - Country:US
Mailing Address - Phone:704-920-1000
Mailing Address - Fax:704-920-1002
Practice Address - Street 1:363 CHURCH ST N STE 250V
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4525
Practice Address - Country:US
Practice Address - Phone:704-920-1199
Practice Address - Fax:704-934-4270
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0039891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical