Provider Demographics
NPI:1396416160
Name:INABA, SOPHIA HIROMI (APCC, MT-BC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:HIROMI
Last Name:INABA
Suffix:
Gender:F
Credentials:APCC, MT-BC
Other - Prefix:
Other - First Name:HIROMI
Other - Middle Name:
Other - Last Name:INABA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APCC, MT-BC
Mailing Address - Street 1:98 BOSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1002
Mailing Address - Country:US
Mailing Address - Phone:415-551-0975
Mailing Address - Fax:
Practice Address - Street 1:98 BOSWORTH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1002
Practice Address - Country:US
Practice Address - Phone:415-551-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
CAAPCC12707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program