Provider Demographics
NPI:1558791012
Name:JENNINGS, SONIA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:MICHELLE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19707 KLINGER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1770
Mailing Address - Country:US
Mailing Address - Phone:313-784-1635
Mailing Address - Fax:
Practice Address - Street 1:2727 2ND AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2658
Practice Address - Country:US
Practice Address - Phone:313-578-6117
Practice Address - Fax:313-963-0103
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2431859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional