Healthcare Provider Details

I. General information

NPI: 1245378306
Provider Name (Legal Business Name): SONYA MARNIQUE ANDERSON PH.D,,LPC,NCC,NCSC,C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 BENJAMIN E MAYS DR SW
ATLANTA GA
30311-3233
US

IV. Provider business mailing address

PO BOX 42251
ATLANTA GA
30311-0251
US

V. Phone/Fax

Practice location:
  • Phone: 404-401-7619
  • Fax: 404-696-7205
Mailing address:
  • Phone: 404-401-7619
  • Fax: 404-696-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC003554
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003554
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberLPC003554
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: