Provider Demographics
NPI:1952679441
Name:GREEN, SONJI ANTOINETTE
Entity Type:Individual
Prefix:
First Name:SONJI
Middle Name:ANTOINETTE
Last Name:GREEN
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 1:1785 E SAHARA AVE
Mailing Address - Street 2:SUITE 445
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3733
Mailing Address - Country:US
Mailing Address - Phone:702-576-0534
Mailing Address - Fax:702-369-5605
Practice Address - Street 1:1785 E SAHARA AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3733
Practice Address - Country:US
Practice Address - Phone:702-576-0534
Practice Address - Fax:702-369-5605
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker