Provider Demographics
NPI:1417679903
Name:EKSTROM, SONYA GRACE (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:GRACE
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 WARING ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5540
Mailing Address - Country:US
Mailing Address - Phone:530-220-2421
Mailing Address - Fax:
Practice Address - Street 1:1010 CASS ST STE C3
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4515
Practice Address - Country:US
Practice Address - Phone:831-272-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist