Healthcare Provider Details

I. General information

NPI: 1255247102
Provider Name (Legal Business Name): SOBIA AHMED LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 CRESCENT DR
BORDENTOWN NJ
08505-2257
US

IV. Provider business mailing address

10737 BREAKING ROCKS DR
TAMPA FL
33647-3591
US

V. Phone/Fax

Practice location:
  • Phone: 954-610-7647
  • Fax:
Mailing address:
  • Phone: 609-356-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00901600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: