Provider Demographics
NPI:1295743268
Name:SOFRAN, MARTHA ADAIR (MA, LLP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ADAIR
Last Name:SOFRAN
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:JANE
Other - Last Name:ADAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:6549 TOWN CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:248-620-6405
Practice Address - Street 1:6549 TOWN CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4824
Practice Address - Country:US
Practice Address - Phone:248-620-6400
Practice Address - Fax:248-620-6405
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009385103TC0700X
MI6361003944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical