Healthcare Provider Details

I. General information

NPI: 1356276141
Provider Name (Legal Business Name): SOPHIE HANNAH ROSE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 EL CAMINO REAL STE J
ATASCADERO CA
93422-2700
US

IV. Provider business mailing address

PO BOX 1198
SACRAMENTO CA
95812-1198
US

V. Phone/Fax

Practice location:
  • Phone: 805-215-8876
  • Fax:
Mailing address:
  • Phone: 805-634-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number22583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22583
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: