Provider Demographics
NPI:1306570916
Name:TOUCH, SOVANNCHAMPA
Entity type:Individual
Prefix:MRS
First Name:SOVANNCHAMPA
Middle Name:
Last Name:TOUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 CORONA CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-6500
Mailing Address - Country:US
Mailing Address - Phone:786-431-8380
Mailing Address - Fax:
Practice Address - Street 1:3848 CORONA CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-6500
Practice Address - Country:US
Practice Address - Phone:786-431-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL169081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical