Provider Demographics
NPI:1073613873
Name:SOHN, GEMMA I (LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:I
Last Name:SOHN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 OWAISSA RD SE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5929
Mailing Address - Country:US
Mailing Address - Phone:703-597-9334
Mailing Address - Fax:
Practice Address - Street 1:220 LUKASIK AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5409
Practice Address - Country:US
Practice Address - Phone:850-665-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD099791041C0700X
VA09040035451041C0700X
FLSW202571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD465302500Medicaid
MD483700200Medicaid