Provider Demographics
NPI:1609123892
Name:DAVIDSON, SONYA (CADC UNDERSUPERVISIO)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CADC UNDERSUPERVISIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-0397
Mailing Address - Country:US
Mailing Address - Phone:918-453-5504
Mailing Address - Fax:
Practice Address - Street 1:17091 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74465-0000
Practice Address - Country:US
Practice Address - Phone:918-453-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)