Healthcare Provider Details

I. General information

NPI: 1851663173
Provider Name (Legal Business Name): SONYA MECHELLE GEORGE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 LATHAM ST STE 110
RIVERSIDE CA
92501-1773
US

IV. Provider business mailing address

4344 LATHAM ST STE 110
RIVERSIDE CA
92501-1773
US

V. Phone/Fax

Practice location:
  • Phone: 951-779-4917
  • Fax:
Mailing address:
  • Phone: 951-779-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1316
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 52646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: