Provider Demographics
NPI:1851862726
Name:ANDERSON, SONJIA B
Entity Type:Individual
Prefix:
First Name:SONJIA
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 CHESEPEAKE TRL
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2225
Mailing Address - Country:US
Mailing Address - Phone:678-521-2028
Mailing Address - Fax:
Practice Address - Street 1:560 HIGHWAY 138 W
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-2222
Practice Address - Country:US
Practice Address - Phone:770-837-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW002149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health