Provider Demographics
NPI:1497848121
Name:SOPHIEA, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SOPHIEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6887 DIXIE
Mailing Address - Street 2:HWY
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48350
Mailing Address - Country:US
Mailing Address - Phone:248-620-1019
Mailing Address - Fax:248-620-1026
Practice Address - Street 1:6887 DIXIE
Practice Address - Street 2:HWY
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48350
Practice Address - Country:US
Practice Address - Phone:248-620-1019
Practice Address - Fax:248-620-1026
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005735103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling