MEDICARE: DR. SONYA MARNIQUE ANDERSON PH.D,,LPC,NCC,NCSC,C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC003554	GA
2	101YP2500X	Professional Counselor	LPC003554	GA
3	101YS0200X	School Counselor	LPC003554	GA

General Provider Information

NPI Number	:	1245378306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONYA MARNIQUE ANDERSON PH.D,,LPC,NCC,NCSC,C

Provider Business Mailing Address
First Line	:	PO BOX 42251
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-0251
Country	:	US
Telephone Number	:	404-401-7619
Fax Number	:	404-696-7205

Provider Business Practice Location Address
First Line	:	2391 BENJAMIN E MAYS DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-3233
Country	:	US
Telephone Number	:	404-401-7619
Fax Number	:	404-696-7205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/11/2025

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