Provider Demographics
NPI:1417099003
Name:SERDA, SONJIA (LPC,MFT-WY, LMHP,CPC)
Entity Type:Individual
Prefix:MRS
First Name:SONJIA
Middle Name:
Last Name:SERDA
Suffix:
Gender:F
Credentials:LPC,MFT-WY, LMHP,CPC
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 22432
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2408
Mailing Address - Country:US
Mailing Address - Phone:307-637-3100
Mailing Address - Fax:
Practice Address - Street 1:2122 HOUSE AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3737
Practice Address - Country:US
Practice Address - Phone:307-514-2781
Practice Address - Fax:307-426-4246
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YM0800X, 101YP2500X
WY918101YP2500X
WY218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist