Provider Demographics
NPI:1093877458
Name:NEW, SONJA PHYLLIS (MFC)
Entity Type:Individual
Prefix:MS
First Name:SONJA
Middle Name:PHYLLIS
Last Name:NEW
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525-1237
Mailing Address - Country:US
Mailing Address - Phone:707-567-2497
Mailing Address - Fax:
Practice Address - Street 1:628 2ND AVE STE 206
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525-1175
Practice Address - Country:US
Practice Address - Phone:707-567-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 32744OtherMARRIAGE AND FAMILY THERA