Provider Demographics
NPI:1821581786
Name:SOPHISTICATED ONE COUNSELING
Entity Type:Organization
Organization Name:SOPHISTICATED ONE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:VIOLA
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW MALICDC
Authorized Official - Phone:216-346-8608
Mailing Address - Street 1:4207 SACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1286
Mailing Address - Country:US
Mailing Address - Phone:216-346-8608
Mailing Address - Fax:216-273-7974
Practice Address - Street 1:4207 SACKETT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1286
Practice Address - Country:US
Practice Address - Phone:216-346-8608
Practice Address - Fax:216-273-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272982Medicaid