Provider Demographics
NPI:1699527135
Name:TATUM, SONJA G (CSAM,YMHFA)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:G
Last Name:TATUM
Suffix:
Gender:F
Credentials:CSAM,YMHFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 ORCUTT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-2247
Mailing Address - Country:US
Mailing Address - Phone:757-660-8827
Mailing Address - Fax:
Practice Address - Street 1:7408 ORCUTT AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2247
Practice Address - Country:US
Practice Address - Phone:757-660-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health