Provider Demographics
NPI:1053109660
Name:BEACH, SONYA (ALC, CRC, RN)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:BEACH
Suffix:
Gender:
Credentials:ALC, CRC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 SETTER TRL
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-4905
Mailing Address - Country:US
Mailing Address - Phone:334-500-0693
Mailing Address - Fax:
Practice Address - Street 1:296 SETTER TRL
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-4905
Practice Address - Country:US
Practice Address - Phone:334-500-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-065216163W00000X
IL730415225C00000X
ALALC05217101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered Nurse
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor