Healthcare Provider Details

I. General information

NPI: 1396469557
Provider Name (Legal Business Name): EFFUA ERICA SOSOO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 HAMMOND BUSINESS PL
RALEIGH NC
27603-3666
US

IV. Provider business mailing address

3040 HAMMOND BUSINESS PL
RALEIGH NC
27603-3666
US

V. Phone/Fax

Practice location:
  • Phone: 919-899-6259
  • Fax:
Mailing address:
  • Phone: 919-899-6259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number103476
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6218
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6218
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: