Healthcare Provider Details

I. General information

NPI: 1629213798
Provider Name (Legal Business Name): SONDRA BROSOFSKE HARRY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 RICEVILLE RD
ASHEVILLE NC
28805-8709
US

IV. Provider business mailing address

31 MADELYN LN
FAIRVIEW NC
28730-8524
US

V. Phone/Fax

Practice location:
  • Phone: 540-273-3213
  • Fax:
Mailing address:
  • Phone: 540-273-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number5462
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5462
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number5462
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number5462
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number5462
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5462
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: