Healthcare Provider Details

I. General information

NPI: 1386800787
Provider Name (Legal Business Name): SOR ORTIZ COLON MA, PH. D., LPC,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 WELLS RD STE 1
ORANGE PARK FL
32073-6766
US

IV. Provider business mailing address

1855 WELLS RD STE 1
ORANGE PARK FL
32073-6766
US

V. Phone/Fax

Practice location:
  • Phone: 904-523-1287
  • Fax:
Mailing address:
  • Phone: 904-523-1287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC3929
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberPR-22-0013
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2321
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: