Provider Demographics
NPI:1043918683
Name:CECIL, SOPHIA (LSW, MATS, ACIT II)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:CECIL
Suffix:
Gender:F
Credentials:LSW, MATS, ACIT II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 E 46TH ST STE J
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2373
Mailing Address - Country:US
Mailing Address - Phone:317-893-3619
Mailing Address - Fax:
Practice Address - Street 1:2626 E 46TH ST STE J
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2373
Practice Address - Country:US
Practice Address - Phone:317-893-3619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010677A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker