Provider Demographics
NPI:1619220787
Name:BLICK, SONYA RENEE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:RENEE
Last Name:BLICK
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CEDAR FIELD LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-1314
Mailing Address - Country:US
Mailing Address - Phone:803-734-4525
Mailing Address - Fax:803-734-4538
Practice Address - Street 1:1205 PENDLETON ST
Practice Address - Street 2:SUITE 372 BROWN BUILDING
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3756
Practice Address - Country:US
Practice Address - Phone:803-734-4525
Practice Address - Fax:803-734-4538
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC170104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical