=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396115747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONYA L COWART LAPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2015
-----------------------------------------------------
Last Update Date | 09/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 LAKESHORE DR STE D
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31558-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-729-1120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 178 HIGH POINT RD
-----------------------------------------------------
City | WOODBINE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31569-2150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-322-0286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | APC005090
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------