Individual
CHANNING ANNE SOFKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
BAY PINES VAHCS, 10000 BAY PINES BLVD, BAY PINES, FL 33744
(727) 398-6661
Mailing address
PO BOX 5005, BAY PINES, FL 33744-5005
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS01739
RI
Other
Enumeration date
03/29/2019
Last updated
05/05/2019
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