Provider Demographics
NPI:1922425479
Name:PENAFIEL, SOPHIA LEIGH (LMHC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LEIGH
Last Name:PENAFIEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 PALM COAST PKWY SW UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4768
Mailing Address - Country:US
Mailing Address - Phone:386-243-9299
Mailing Address - Fax:
Practice Address - Street 1:395 PALM COAST PKWY SW UNIT 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4768
Practice Address - Country:US
Practice Address - Phone:386-243-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH14996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020634100Medicaid