Healthcare Provider Details

I. General information

NPI: 1003751611
Provider Name (Legal Business Name): SOPHIA V MAXWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6481 BURNING OPAL BND
LAND O LAKES FL
34638-3873
US

IV. Provider business mailing address

6481 BURNING OPAL BND
LAND O LAKES FL
34638-3873
US

V. Phone/Fax

Practice location:
  • Phone: 813-892-9515
  • Fax:
Mailing address:
  • Phone: 813-892-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: