Provider Demographics
NPI:1194325472
Name:WARE, SOPHIA (MHT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:MHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4981
Mailing Address - Country:US
Mailing Address - Phone:601-602-2040
Mailing Address - Fax:601-336-8935
Practice Address - Street 1:1306 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4981
Practice Address - Country:US
Practice Address - Phone:601-602-2040
Practice Address - Fax:601-336-8935
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health