Provider Demographics
NPI:1245378306
Name:ANDERSON, SONYA MARNIQUE (PHD,,LPC,NCC,NCSC,C)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:MARNIQUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD,,LPC,NCC,NCSC,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42251
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-0251
Mailing Address - Country:US
Mailing Address - Phone:404-401-7619
Mailing Address - Fax:404-696-7205
Practice Address - Street 1:2391 BENJAMIN E MAYS DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3233
Practice Address - Country:US
Practice Address - Phone:404-401-7619
Practice Address - Fax:404-696-7205
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003554101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC003554Medicare UPIN