Provider Demographics
NPI:1598826323
Name:MAS, SOPHIA XIQUES (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:XIQUES
Last Name:MAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 GRAND HICKORY CIR
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3139
Mailing Address - Country:US
Mailing Address - Phone:386-334-6397
Mailing Address - Fax:386-236-3162
Practice Address - Street 1:301 JUSTICE LN
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-4487
Practice Address - Country:US
Practice Address - Phone:386-236-1726
Practice Address - Fax:386-236-3162
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health