Healthcare Provider Details

I. General information

NPI: 1669682795
Provider Name (Legal Business Name): SOPHIA M CLIFFORD BA, CADTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N DUTTON AVE STE 220
SANTA ROSA CA
95401-4686
US

IV. Provider business mailing address

1260 N DUTTON AVE STE 220
SANTA ROSA CA
95401-4686
US

V. Phone/Fax

Practice location:
  • Phone: 707-568-2300
  • Fax: 707-568-2304
Mailing address:
  • Phone: 707-568-2300
  • Fax: 707-568-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: