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General NPI Number Information
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NPI Number | 1841798097
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Entity Type | Individual
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Provider Name | MISTY CHERI SORRELL LICDC-CS, LSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 436 WESTERN AVE
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-2343
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Country | US
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Telephone | 740-309-3309
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Fax |
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Provider Business Mailing Address
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Address Line | 436 WEATERN AVENUE
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City | CHILLICOTHEE
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State | OH
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Zip | 45601
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Country | US
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Telephone | 740-309-3309
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.162043
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2106712
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License Number State | OH
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