Provider Demographics
NPI:1962474932
Name:SOPHIA COUNSELING CENTER INC
Entity Type:Organization
Organization Name:SOPHIA COUNSELING CENTER INC
Other - Org Name:SOPHIA CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NIJAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-882-4529
Mailing Address - Street 1:6832 CONVENT BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4805
Mailing Address - Country:US
Mailing Address - Phone:419-882-4529
Mailing Address - Fax:419-885-7612
Practice Address - Street 1:6832 CONVENT BLVD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4805
Practice Address - Country:US
Practice Address - Phone:419-882-4529
Practice Address - Fax:419-885-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9266571Medicare PIN
OH9266572Medicare PIN