Provider Demographics
NPI:1679884134
Name:COMER, SONJA (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:COMER
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ENTERPRISE WAY
Mailing Address - Street 2:SUITE 68
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 ENTERPRISE WAY
Practice Address - Street 2:SUITE 68
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4442
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26656101YA0400X
IL149.0137741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)