Provider Demographics
NPI:1669217097
Name:BOOTH, SONDRA MARIE (LPC/A)
Entity type:Individual
Prefix:
First Name:SONDRA
Middle Name:MARIE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LPC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4093 MICA AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6480
Mailing Address - Country:US
Mailing Address - Phone:843-997-2443
Mailing Address - Fax:
Practice Address - Street 1:141 MCDONALD CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6134
Practice Address - Country:US
Practice Address - Phone:843-297-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional