Healthcare Provider Details

I. General information

NPI: 1376542886
Provider Name (Legal Business Name): SONIA RACHEL PONE MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 HAYNES ST STE 250
BIRMINGHAM MI
48009-6715
US

IV. Provider business mailing address

30234 HIGH VALLEY RD
FARMINGTON HILLS MI
48331-2166
US

V. Phone/Fax

Practice location:
  • Phone: 248-258-4939
  • Fax: 248-258-4939
Mailing address:
  • Phone: 248-821-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801004129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: