Provider Demographics
NPI:1184108482
Name:SONRISA MIA, LLC
Entity type:Organization
Organization Name:SONRISA MIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:OSYMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-452-3428
Mailing Address - Street 1:9114 SMOKETREE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-7400
Mailing Address - Country:US
Mailing Address - Phone:904-452-3428
Mailing Address - Fax:
Practice Address - Street 1:9114 SMOKETREE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7400
Practice Address - Country:US
Practice Address - Phone:904-452-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty