Provider Demographics
NPI:1790817229
Name:SONIA C. MIELKE
Entity Type:Organization
Organization Name:SONIA C. MIELKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIELKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-472-8558
Mailing Address - Street 1:300 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2673
Mailing Address - Country:US
Mailing Address - Phone:954-472-8558
Mailing Address - Fax:954-472-8330
Practice Address - Street 1:300 S PINE ISLAND RD
Practice Address - Street 2:SUITE 212
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2673
Practice Address - Country:US
Practice Address - Phone:954-472-8558
Practice Address - Fax:954-472-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty