Provider Demographics
NPI:1043672868
Name:RAE, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:RAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 10TH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7050
Mailing Address - Country:US
Mailing Address - Phone:360-329-2055
Mailing Address - Fax:360-547-7780
Practice Address - Street 1:1140 10TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7050
Practice Address - Country:US
Practice Address - Phone:360-329-2055
Practice Address - Fax:360-547-7780
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60064000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist