Provider Demographics
NPI:1770114431
Name:SIRAJ, SOFIA ELIZABETH (CRC, APC, NCC)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:ELIZABETH
Last Name:SIRAJ
Suffix:
Gender:F
Credentials:CRC, APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 NORWOOD PARK XING
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1855
Mailing Address - Country:US
Mailing Address - Phone:678-877-5905
Mailing Address - Fax:
Practice Address - Street 1:302 STEVENS ENTRY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1325
Practice Address - Country:US
Practice Address - Phone:770-486-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor