Provider Demographics
NPI:1811350077
Name:SOFALY, CHRISTY DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:DIANE
Last Name:SOFALY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-5020
Mailing Address - Country:US
Mailing Address - Phone:208-315-3308
Mailing Address - Fax:208-639-5738
Practice Address - Street 1:299 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5020
Practice Address - Country:US
Practice Address - Phone:208-315-3308
Practice Address - Fax:208-639-5738
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-341221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical