Healthcare Provider Details

I. General information

NPI: 1164554366
Provider Name (Legal Business Name): DAVID LORAN SORENSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 E. 8TH AVE.
CHICO CA
95926
US

IV. Provider business mailing address

P. O. BOX 5476
CHICO CA
95927-5476
US

V. Phone/Fax

Practice location:
  • Phone: 530-898-0722
  • Fax:
Mailing address:
  • Phone: 530-898-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 14984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: