Provider Demographics
NPI:1427384023
Name:LHERISSE, SOPHONIE (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:SOPHONIE
Middle Name:
Last Name:LHERISSE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:LHERISSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIFE COACH
Mailing Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7270
Mailing Address - Country:US
Mailing Address - Phone:954-300-3135
Mailing Address - Fax:
Practice Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7270
Practice Address - Country:US
Practice Address - Phone:954-300-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist