Provider Demographics
NPI:1467087197
Name:EASTHAM, SONYA (LPCC)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 157TH WAY N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-8471
Mailing Address - Country:US
Mailing Address - Phone:651-600-7328
Mailing Address - Fax:
Practice Address - Street 1:3820 CLEVELAND AVE N STE 400
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3297
Practice Address - Country:US
Practice Address - Phone:651-600-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health