Provider Demographics
NPI:1851663173
Name:GEORGE, SONYA MECHELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:MECHELLE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 LATHAM ST STE 110
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1773
Mailing Address - Country:US
Mailing Address - Phone:951-779-4917
Mailing Address - Fax:
Practice Address - Street 1:4344 LATHAM ST STE 110
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1773
Practice Address - Country:US
Practice Address - Phone:951-779-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1316106H00000X
CAMFC 52646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist