Provider Demographics
NPI:1366000911
Name:DAWSON, SOPHIA CORRINE SOLEIL (LSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:CORRINE SOLEIL
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LSW, LCSW
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:CORRINE SOLEIL
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, LCSW
Mailing Address - Street 1:3420 N ROCHELLE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1035
Mailing Address - Country:US
Mailing Address - Phone:309-282-1087
Mailing Address - Fax:309-282-1089
Practice Address - Street 1:3400 W NEW LEAF LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3311
Practice Address - Country:US
Practice Address - Phone:309-589-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0209111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical