Provider Demographics
NPI:1942832340
Name:NABORS, SOPHIE ANN
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ANN
Last Name:NABORS
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 1:10497 DAMASCUS PARK LN
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2733
Mailing Address - Country:US
Mailing Address - Phone:240-723-5607
Mailing Address - Fax:
Practice Address - Street 1:406 CAMPUS VIEW DR APT 4106
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6869
Practice Address - Country:US
Practice Address - Phone:240-723-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N162772067861106S00000X
MDN162772067861106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician