Provider Demographics
NPI:1558416222
Name:SONEN, SOPHIA (LCADC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:SONEN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 M. GEORGIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5792
Mailing Address - Country:US
Mailing Address - Phone:410-548-3716
Mailing Address - Fax:
Practice Address - Street 1:CENTER 4 CLEAN START
Practice Address - Street 2:1001 LAKE STREET
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-742-3460
Practice Address - Fax:410-742-5810
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS013Medicare ID - Type Unspecified