Provider Demographics
NPI:1497027510
Name:SHAVERS, SONJA (LCSW, EDD)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:
Last Name:SHAVERS
Suffix:
Gender:F
Credentials:LCSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6583
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6583
Mailing Address - Country:US
Mailing Address - Phone:478-227-4054
Mailing Address - Fax:
Practice Address - Street 1:100 KATELYN CIR STE F
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6483
Practice Address - Country:US
Practice Address - Phone:478-227-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-05
Last Update Date:2012-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0044581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical