Provider Demographics
NPI:1518145929
Name:ACOSTA, SONIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W HURON ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2120
Mailing Address - Country:US
Mailing Address - Phone:248-858-7800
Mailing Address - Fax:248-874-4830
Practice Address - Street 1:35 W HURON ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2120
Practice Address - Country:US
Practice Address - Phone:248-858-7800
Practice Address - Fax:248-874-4830
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301006874OtherFULL LICENSE