Provider Demographics
NPI:1134372840
Name:FORD-BECTON, SONYA
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:FORD-BECTON
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 1:603 POST OFFICE RD
Mailing Address - Street 2:STE 210
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 POST OFFICE RD
Practice Address - Street 2:STE 210
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1914
Practice Address - Country:US
Practice Address - Phone:301-705-7593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
624LMedicare UPIN