Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C003989 | NC |
NPI | 1003057969 |
---|---|
Provider Name | Ms. Sonja Jo Bohannon-Thacker |
First Address | Kannapolis, NC 28081-0304 |
Second Address | Kannapolis, NC 28081-0304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 01/05/2012 |