Provider Demographics
NPI:1639986615
Name:MEDINA, SONYA MARIE (RBT)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:MARIE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 GEORGE WASHINGTON MEM HWY STE D
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3350
Mailing Address - Country:US
Mailing Address - Phone:757-586-5252
Mailing Address - Fax:
Practice Address - Street 1:3630 GEORGE WASHINGTON MEM HWY STE D
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3350
Practice Address - Country:US
Practice Address - Phone:757-586-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-24-399294106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician