Provider Demographics
NPI:1356782098
Name:SHIPP, SONJA LYNETTE (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:LYNETTE
Last Name:SHIPP
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:LYNETTE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5787 SOUTH HAMPTON ROAD SUITE 230-K
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232
Mailing Address - Country:US
Mailing Address - Phone:469-730-3360
Mailing Address - Fax:469-730-3361
Practice Address - Street 1:5787 SOUTH HAMPTON ROAD, SUITE 230-K
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232
Practice Address - Country:US
Practice Address - Phone:469-730-3360
Practice Address - Fax:469-730-3361
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11144101YA0400X
TX65614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)