Provider Demographics
NPI:1093218026
Name:WHITEHEAD, SONYA K (LAC)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:K
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 N WOODROSE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3191
Mailing Address - Country:US
Mailing Address - Phone:520-886-4089
Mailing Address - Fax:
Practice Address - Street 1:760 N WOODROSE PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3191
Practice Address - Country:US
Practice Address - Phone:520-886-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1073171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist