Provider Demographics
NPI:1336779651
Name:SONNY SIDE OF COACHING
Entity Type:Organization
Organization Name:SONNY SIDE OF COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MEYERS-GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, CLC
Authorized Official - Phone:619-313-7304
Mailing Address - Street 1:616 E ST NW APT 1007
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-2275
Mailing Address - Country:US
Mailing Address - Phone:202-560-7967
Mailing Address - Fax:
Practice Address - Street 1:616 E ST NW APT 1007
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-2275
Practice Address - Country:US
Practice Address - Phone:202-560-7967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management