Provider Demographics
NPI:1396469557
Name:SOSOO, EFFUA ERICA (PHD)
Entity type:Individual
Prefix:DR
First Name:EFFUA
Middle Name:ERICA
Last Name:SOSOO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 HAMMOND BUSINESS PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3666
Mailing Address - Country:US
Mailing Address - Phone:919-899-6259
Mailing Address - Fax:
Practice Address - Street 1:3040 HAMMOND BUSINESS PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3666
Practice Address - Country:US
Practice Address - Phone:919-899-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103476103T00000X
NC6218103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service