Healthcare Provider Details

I. General information

NPI: 1003057969
Provider Name (Legal Business Name): SONJA JO BOHANNON-THACKER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOORESVILLE ROAD
KANNAPOLIS NC
28081-0304
US

IV. Provider business mailing address

300 MOORESVILLE RD
KANNAPOLIS NC
28081-0304
US

V. Phone/Fax

Practice location:
  • Phone: 704-920-1000
  • Fax: 704-920-1002
Mailing address:
  • Phone: 704-920-1000
  • Fax: 704-934-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003989
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: