Provider Demographics
NPI:1104678713
Name:PALMER, SOPHIA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:L
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 JB IVEY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE JUNALUSKA
Mailing Address - State:NC
Mailing Address - Zip Code:28745-8748
Mailing Address - Country:US
Mailing Address - Phone:541-661-0660
Mailing Address - Fax:
Practice Address - Street 1:30 JB IVEY LN
Practice Address - Street 2:
Practice Address - City:LAKE JUNALUSKA
Practice Address - State:NC
Practice Address - Zip Code:28745-8748
Practice Address - Country:US
Practice Address - Phone:541-661-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker