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General NPI Number Information
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NPI Number | 1982764874
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Entity Type | Individual
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Provider Name | SONJA TERRY VAN LAAR PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1504 KINGS HWY UNIT 300
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-5240
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Country | US
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Telephone | 800-457-4573
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Fax | 800-443-6422
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Provider Business Mailing Address
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Address Line | 15544 W COLONIAL DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-9556
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Country | US
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Telephone | 800-457-4573
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Fax | 800-443-6422
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 18404
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY11919
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License Number State | FL
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