Healthcare Provider Details

I. General information

NPI: 1871689547
Provider Name (Legal Business Name): DAVID ALAN SORENSEN ED.D., LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 MENAUL NE STE. A
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

3301 R COORS RD. NW STE. 265
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-3512
  • Fax: 505-254-3574
Mailing address:
  • Phone: 505-440-3512
  • Fax: 505-254-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4266
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: