Healthcare Provider Details

I. General information

NPI: 1053109660
Provider Name (Legal Business Name): SONYA BEACH LPC, CRC, NCC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 SAINT LUKES DR
MONTGOMERY AL
36117-7105
US

IV. Provider business mailing address

495 SAINT LUKES DR
MONTGOMERY AL
36117-7105
US

V. Phone/Fax

Practice location:
  • Phone: 334-500-0693
  • Fax:
Mailing address:
  • Phone: 334-500-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-065216
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number730415
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05974
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: