Provider Demographics
NPI:1891495081
Name:CORREA, SONIA XOCHITL (MA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:XOCHITL
Last Name:CORREA
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4064
Mailing Address - Country:US
Mailing Address - Phone:858-609-7765
Mailing Address - Fax:
Practice Address - Street 1:960 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4064
Practice Address - Country:US
Practice Address - Phone:858-609-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10949101YP2500X
CA130077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional