Provider Demographics
NPI:1417658485
Name:GONSOULIN, SOPHIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:GONSOULIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 N HALL ST APT 320
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1287
Mailing Address - Country:US
Mailing Address - Phone:409-789-3394
Mailing Address - Fax:
Practice Address - Street 1:3140 N HALL ST APT 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1287
Practice Address - Country:US
Practice Address - Phone:409-789-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical