=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770848970
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONJA K LYONS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2012
-----------------------------------------------------
Last Update Date | 07/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 ROCK QUARRY RD
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-565-8700
-----------------------------------------------------
Fax | 678-565-8775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1592 GALLUP DR
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-2480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-263-4204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW004340
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------