Provider Demographics
NPI:1053143594
Name:BLACK, SOPHIA CHRISTINE
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:CHRISTINE
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16431 MILL POINT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 S FRIENDSWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4543
Practice Address - Country:US
Practice Address - Phone:281-947-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist