Provider Demographics
NPI:1740290733
Name:CLARK, SONJA DANA (PSYD, LPCC)
Entity type:Individual
Prefix:DR
First Name:SONJA
Middle Name:DANA
Last Name:CLARK
Suffix:
Gender:F
Credentials:PSYD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 21403
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1403
Mailing Address - Country:US
Mailing Address - Phone:505-710-4323
Mailing Address - Fax:505-265-3844
Practice Address - Street 1:6000 SUMMER NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-710-4323
Practice Address - Fax:505-265-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00067412101YM0800X
NM0067412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health