Provider Demographics
NPI:1033788849
Name:SOJACK, MITCHELL (LCSW, PHD, MPA)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:SOJACK
Suffix:
Gender:M
Credentials:LCSW, PHD, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SUNKEN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4534
Mailing Address - Country:US
Mailing Address - Phone:540-845-7683
Mailing Address - Fax:540-370-0110
Practice Address - Street 1:1715 SUNKEN RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4534
Practice Address - Country:US
Practice Address - Phone:540-845-7683
Practice Address - Fax:540-370-0110
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health