Provider Demographics
NPI:1518275643
Name:DUQUE-MIYASHITA, SONIA M (LPC, LCDC)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:M
Last Name:DUQUE-MIYASHITA
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 HAYDENBEND CIR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7336
Mailing Address - Country:US
Mailing Address - Phone:817-416-5792
Mailing Address - Fax:
Practice Address - Street 1:1812 HAYDENBEND CIR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7336
Practice Address - Country:US
Practice Address - Phone:817-416-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10819101YA0400X
TX64612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)