Healthcare Provider Details

I. General information

NPI: 1346466877
Provider Name (Legal Business Name): SONJA L MIDDLETON LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONJA LYNN ROBBINS LCSW

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 WILDWOOD LN
LUGOFF SC
29078-9096
US

IV. Provider business mailing address

358 WILDWOOD LN
LUGOFF SC
29078-9096
US

V. Phone/Fax

Practice location:
  • Phone: 803-420-6723
  • Fax:
Mailing address:
  • Phone: 803-420-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1788-C
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12468
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: