Provider Demographics
NPI:1669682795
Name:CLIFFORD, SOPHIA M (BA, CADTP)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:M
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:BA, CADTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1260 N DUTTON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4686
Mailing Address - Country:US
Mailing Address - Phone:707-568-2300
Mailing Address - Fax:707-568-2304
Practice Address - Street 1:1260 N DUTTON AVE STE 220
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4686
Practice Address - Country:US
Practice Address - Phone:707-568-2300
Practice Address - Fax:707-568-2304
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker