Provider Demographics
NPI:1881352672
Name:POOLE, SONJA DENISE
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:DENISE
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:DENISE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR SONJA POOLE
Mailing Address - Street 1:90 DEER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3129
Mailing Address - Country:US
Mailing Address - Phone:704-303-3554
Mailing Address - Fax:
Practice Address - Street 1:90 DEER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3129
Practice Address - Country:US
Practice Address - Phone:704-303-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health