Healthcare Provider Details

I. General information

NPI: 1962663260
Provider Name (Legal Business Name): MS. SOPHIA MONIQUE MANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

PO BOX 6353
VENTURA CA
93006-6353
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6161
  • Fax: 805-652-6164
Mailing address:
  • Phone: 805-652-6161
  • Fax: 805-652-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: