Healthcare Provider Details

I. General information

NPI: 1932031127
Provider Name (Legal Business Name): MISS VEGA SONATA POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 NORTHWESTERN HWY
SOUTHFIELD MI
48075-7710
US

IV. Provider business mailing address

9973 LITTLEFIELD ST
DETROIT MI
48227-3428
US

V. Phone/Fax

Practice location:
  • Phone: 313-264-2224
  • Fax: 248-900-2166
Mailing address:
  • Phone: 313-264-2224
  • Fax: 313-264-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberP900000144492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: