Provider Demographics
NPI:1164515250
Name:HERRON, SONYA MARIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:MARIA
Last Name:HERRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3550
Mailing Address - Country:US
Mailing Address - Phone:314-521-7900
Mailing Address - Fax:
Practice Address - Street 1:9167 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1420
Practice Address - Country:US
Practice Address - Phone:314-521-7900
Practice Address - Fax:314-521-2786
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000165882101YM0800X
IL101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health