Provider Demographics
NPI:1710612213
Name:DOUGLAS, SONYA RENEE
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:RENEE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 JUSTICE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3618
Mailing Address - Country:US
Mailing Address - Phone:318-807-2025
Mailing Address - Fax:318-807-2028
Practice Address - Street 1:2116 JUSTICE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3618
Practice Address - Country:US
Practice Address - Phone:318-807-2025
Practice Address - Fax:318-807-2028
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy