Provider Demographics
NPI:1194195024
Name:DUBOSE, SONIA (MSW, LSW, CADC)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:MSW, LSW, CADC
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:MARES DUBOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3010 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2321
Mailing Address - Country:US
Mailing Address - Phone:847-377-8296
Mailing Address - Fax:847-984-5639
Practice Address - Street 1:218 N COUNTY ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4220
Practice Address - Country:US
Practice Address - Phone:847-561-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36580101YA0400X
IL150.108061104100000X, 101Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program