Provider Demographics
NPI:1992179923
Name:SMALLEY, SONYA ANN
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:ANN
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:ANN
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 NW 44TH ST APT 214F
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6047
Mailing Address - Country:US
Mailing Address - Phone:901-289-3225
Mailing Address - Fax:
Practice Address - Street 1:214 NW 44TH ST APT 214F
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6047
Practice Address - Country:US
Practice Address - Phone:901-289-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)