Provider Demographics
NPI:1417141417
Name:SOBER, ANNETTE (LADC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:SOBER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:SOBER-SEGUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5575 SIMMONS ST
Mailing Address - Street 2:SUITE 1 # 486
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-9009
Mailing Address - Country:US
Mailing Address - Phone:702-217-3743
Mailing Address - Fax:
Practice Address - Street 1:5575 SIMMONS ST
Practice Address - Street 2:SUITE 1 # 486
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-9009
Practice Address - Country:US
Practice Address - Phone:702-217-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5611101YA0400X
NV01504101YA0400X
NV0284-S101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00284-SOtherBOARD OF EXAMINERS