Provider Demographics
NPI:1871995977
Name:FOUCHE, SOPHIA (PHD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:FOUCHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-8697
Mailing Address - Country:US
Mailing Address - Phone:860-230-6947
Mailing Address - Fax:731-661-6277
Practice Address - Street 1:3006 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3589
Practice Address - Country:US
Practice Address - Phone:608-230-6947
Practice Address - Fax:731-661-6277
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36394103TC0700X
TN3271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical