Provider Demographics
NPI:1124150719
Name:BLOOM, SONJA OLSEN (MA)
Entity type:Individual
Prefix:MS
First Name:SONJA
Middle Name:OLSEN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:SUITE # 117
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-780-1533
Mailing Address - Fax:703-780-0947
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE # 117
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-780-1533
Practice Address - Fax:703-780-0947
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040004691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA039335OtherANTHEM BLUE CROSS BLUE SH
VA117291OtherKAISER PERMANENTE
VA117291OtherKAISER PERMANENTE