Healthcare Provider Details

I. General information

NPI: 1871285916
Provider Name (Legal Business Name): THERESA SODA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1387 CHEWS LANDING RD
LAUREL SPRINGS NJ
08021-2760
US

IV. Provider business mailing address

1387 CHEWS LANDING RD
LAUREL SPRINGS NJ
08021-2760
US

V. Phone/Fax

Practice location:
  • Phone: 856-454-3104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00288800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: