Provider Demographics
NPI:1558761346
Name:REID, SOPHIA BRIDGETTE (BHS)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:BRIDGETTE
Last Name:REID
Suffix:
Gender:F
Credentials:BHS
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:BRIDGETTE
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BHS
Mailing Address - Street 1:801 DOUGLAS AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5206
Mailing Address - Country:US
Mailing Address - Phone:407-937-8362
Mailing Address - Fax:
Practice Address - Street 1:302 ROLLINS DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8239
Practice Address - Country:US
Practice Address - Phone:407-937-8362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker