Healthcare Provider Details

I. General information

NPI: 1073744090
Provider Name (Legal Business Name): SOPHRONIA DEE KELLY-ZION LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 EWING HALSELL DR
SAN ANTONIO TX
78229-3715
US

IV. Provider business mailing address

118 ROUTT ST
SAN ANTONIO TX
78209-4662
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-0885
  • Fax: 210-614-5633
Mailing address:
  • Phone: 210-930-7841
  • Fax: 210-614-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: