Provider Demographics
NPI:1770842726
Name:SONDOV, NEIL S
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:S
Last Name:SONDOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 RUTHERFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609
Mailing Address - Country:US
Mailing Address - Phone:864-467-3434
Mailing Address - Fax:864-467-3571
Practice Address - Street 1:1100 RUTHERFORD ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609
Practice Address - Country:US
Practice Address - Phone:864-467-3434
Practice Address - Fax:864-467-3571
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional