Healthcare Provider Details

I. General information

NPI: 1922425479
Provider Name (Legal Business Name): SOPHIA LEIGH PENAFIEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 PALM COAST PKWY SW UNIT 4
PALM COAST FL
32137-4768
US

IV. Provider business mailing address

395 PALM COAST PKWY SW UNIT 4
PALM COAST FL
32137-4768
US

V. Phone/Fax

Practice location:
  • Phone: 386-243-9299
  • Fax:
Mailing address:
  • Phone: 386-243-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: