Provider Demographics
NPI:1891483186
Name:JAVAR, SOPHIA ARIANNE
Entity Type:Individual
Prefix:
First Name:SOPHIA ARIANNE
Middle Name:
Last Name:JAVAR
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 1:4244 65TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2350
Mailing Address - Country:US
Mailing Address - Phone:206-458-4339
Mailing Address - Fax:
Practice Address - Street 1:1900 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3112
Practice Address - Country:US
Practice Address - Phone:253-692-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61141424106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician