Provider Demographics
NPI:1821496928
Name:SONYA B CHAMBLISS COUNSELING SERVICES
Entity Type:Organization
Organization Name:SONYA B CHAMBLISS COUNSELING SERVICES
Other - Org Name:SONYA B CHAMBLISS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CHAMBLISS-ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-435-9926
Mailing Address - Street 1:140 KAHANA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-8314
Mailing Address - Country:US
Mailing Address - Phone:407-435-9926
Mailing Address - Fax:808-442-1056
Practice Address - Street 1:10 HOOHUI RD
Practice Address - Street 2:STE 207
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-9256
Practice Address - Country:US
Practice Address - Phone:808-250-9406
Practice Address - Fax:808-442-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 3861251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health