Provider Demographics
NPI:1376066738
Name:IVY, SONJIA FIELDS
Entity Type:Individual
Prefix:MRS
First Name:SONJIA
Middle Name:FIELDS
Last Name:IVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONJIA
Other - Middle Name:MELANE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6060 FOX CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3535
Mailing Address - Country:US
Mailing Address - Phone:318-573-3768
Mailing Address - Fax:
Practice Address - Street 1:6060 FOX CHASE TRL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3535
Practice Address - Country:US
Practice Address - Phone:318-573-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor