Provider Demographics
NPI:1790240745
Name:CHOAU, SOPHORN THEAM (PHD, LPCC)
Entity Type:Individual
Prefix:DR
First Name:SOPHORN
Middle Name:THEAM
Last Name:CHOAU
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 FLORAL PARK ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4056
Mailing Address - Country:US
Mailing Address - Phone:203-893-7888
Mailing Address - Fax:
Practice Address - Street 1:29995 TECHNOLOGY DR STE 304
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2634
Practice Address - Country:US
Practice Address - Phone:951-643-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111210106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist