Provider Demographics
NPI:1194195024
Name:DUBOSE, SONIA (MSW, LCSW, CADC)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:MSW, LCSW, CADC
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:DUBOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-0022
Mailing Address - Country:US
Mailing Address - Phone:312-608-7369
Mailing Address - Fax:847-984-5639
Practice Address - Street 1:1761 N DILLEYS RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1711
Practice Address - Country:US
Practice Address - Phone:312-608-7369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0271901041C0700X, 101YM0800X
IL36580101YA0400X
IL150.108061104100000X, 101Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194195024OtherMMI