Provider Demographics
NPI:1508140708
Name:POOLE, SONYA PARKER (LPC NCC NCSP)
Entity type:Individual
Prefix:DR
First Name:SONYA
Middle Name:PARKER
Last Name:POOLE
Suffix:
Gender:F
Credentials:LPC NCC NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71049-2346
Mailing Address - Country:US
Mailing Address - Phone:318-469-1556
Mailing Address - Fax:
Practice Address - Street 1:399 JENKINS ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-3128
Practice Address - Country:US
Practice Address - Phone:318-469-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAN576528103TS0200X
LA4230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710113Medicaid
LA1710113Medicaid