Healthcare Provider Details

I. General information

NPI: 1720180102
Provider Name (Legal Business Name): SONJA COLLETTE WILLIAMS LIC PROF COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 ACTON DRIVE
ST LOUIS MO
63123-7003
US

IV. Provider business mailing address

PO BOX 270005
ST LOUIS MO
63127
US

V. Phone/Fax

Practice location:
  • Phone: 314-540-0545
  • Fax: 314-892-8765
Mailing address:
  • Phone: 314-540-0545
  • Fax: 314-892-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2003032184
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: