Healthcare Provider Details

I. General information

NPI: 1366674475
Provider Name (Legal Business Name): SONIA BEATRIZ NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2009
Last Update Date: 08/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 FREDERICK RD
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

13207 DUTROW DR
CLARKSBURG MD
20871-4345
US

V. Phone/Fax

Practice location:
  • Phone: 240-606-5352
  • Fax:
Mailing address:
  • Phone: 240-606-5352
  • Fax: 301-916-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA203
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: