Provider Demographics
NPI:1841516374
Name:SUTHERLAND-FORDE, SONJA (LPC)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:SUTHERLAND-FORDE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 PARKER CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3445
Mailing Address - Country:US
Mailing Address - Phone:678-987-1020
Mailing Address - Fax:678-987-1019
Practice Address - Street 1:1899 PARKER CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3445
Practice Address - Country:US
Practice Address - Phone:678-987-1020
Practice Address - Fax:678-987-1019
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional