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General NPI Number Information
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NPI Number | 1245622992
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Entity Type | Individual
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Provider Name | MRS. SOFIA DENISE OLDS
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Gender | Female
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 3004 CHASE WAY
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City | MARIANNA
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State | FL
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Zip | 32446-6477
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Country | US
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Telephone | 850-616-2833
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 CHASE WAY
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City | MARIANNA
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State | FL
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Zip | 32446-6477
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Country | US
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Telephone | 850-616-2833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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