Healthcare Provider Details

I. General information

NPI: 1316204209
Provider Name (Legal Business Name): STOREY AXWELL MCGREGOR SORENSEN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STOREY CHRISTINE SMITH LISW

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 09/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 VASSAR DR SE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

1720 VASSAR DR SE
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-359-9042
  • Fax:
Mailing address:
  • Phone: 505-485-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1.1100194
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1100194SUPV
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB20231217
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: