Provider Demographics
NPI:1013445725
Name:MAYO, SONJA DIETTA (LMSW)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:DIETTA
Last Name:MAYO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 W WILKE RD
Mailing Address - Street 2:
Mailing Address - City:ROTHBURY
Mailing Address - State:MI
Mailing Address - Zip Code:49452-8004
Mailing Address - Country:US
Mailing Address - Phone:231-893-4264
Mailing Address - Fax:
Practice Address - Street 1:611 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1190
Practice Address - Country:US
Practice Address - Phone:231-873-6900
Practice Address - Fax:231-873-1825
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089271104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker