Provider Demographics
NPI:1891031001
Name:FLEMING, SOPHIA (LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:KRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:17505 N 79TH AVE STE 111A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8724
Mailing Address - Country:US
Mailing Address - Phone:623-277-0228
Mailing Address - Fax:
Practice Address - Street 1:17505 N 79TH AVE STE 111A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8724
Practice Address - Country:US
Practice Address - Phone:623-277-0228
Practice Address - Fax:888-972-3991
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW165071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical