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General NPI Number Information
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NPI Number | 1043298235
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Entity Type | Individual
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Provider Name | MARLENE A SORAH MS
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Gender | Female
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 1 ELIZABETH PL
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City | DAYTON
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State | OH
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Zip | 45408-1445
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Country | US
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Telephone | 937-228-0579
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Fax | 937-228-0592
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Provider Business Mailing Address
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Address Line | 1 ELIZABETH PL STE 111 1195 B MEADOW BRIDGE DRIVE
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City | DAYTON
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State | OH
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Zip | 45408-1445
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Country | US
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Telephone | 937-228-0579
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Fax | 937-228-0592
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E0002155
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License Number State | OH
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