Healthcare Provider Details

I. General information

NPI: 1992068134
Provider Name (Legal Business Name): LORRITA P. HUMES-AUSTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA AUSTIN LCSW

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL RD TUOLUMNE COUNTY BEHAVIORAL HEALTH
SONORA CA
95370-5227
US

IV. Provider business mailing address

105 HOSPITAL RD TUOLUMNE COUNTY BEHAVIORAL HEALTH
SONORA CA
95370-5227
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-6245
  • Fax: 209-588-9528
Mailing address:
  • Phone: 209-533-6245
  • Fax: 209-588-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS10294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: