Provider Demographics
NPI:1598818593
Name:MIELKE, SONIA C
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:C
Last Name:MIELKE
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 1:300 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2673
Mailing Address - Country:US
Mailing Address - Phone:954-472-8558
Mailing Address - Fax:
Practice Address - Street 1:300 S PINE ISLAND RD
Practice Address - Street 2:SUITE 212
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2673
Practice Address - Country:US
Practice Address - Phone:954-472-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health