Provider Demographics
NPI:1659711711
Name:SILLS-TAILOR, SOPHIA (PHD, LPCMH, LPC,)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:SILLS-TAILOR
Suffix:
Gender:F
Credentials:PHD, LPCMH, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 ALDER CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4858
Mailing Address - Country:US
Mailing Address - Phone:757-724-0980
Mailing Address - Fax:
Practice Address - Street 1:5505 INDIAN RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5252
Practice Address - Country:US
Practice Address - Phone:757-724-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15540101YP2500X
VA0701006106101YP2500X
NJ651764101YS0200X
DEPC-0000586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool