Provider Demographics
NPI:1548493109
Name:LARK, SOPHILIA J (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:SOPHILIA
Middle Name:J
Last Name:LARK
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4801 N CLASSEN BLVD
Mailing Address - Street 2:135
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4627
Mailing Address - Country:US
Mailing Address - Phone:405-848-0011
Mailing Address - Fax:405-848-2111
Practice Address - Street 1:4801 N CLASSEN BLVD
Practice Address - Street 2:135
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4627
Practice Address - Country:US
Practice Address - Phone:405-848-0011
Practice Address - Fax:405-848-2111
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health