MEDICARE: CHRISTINE ANGELICA SORIA LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPCC.0014954	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689239261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ANGELICA SORIA LPCC

Provider Business Mailing Address
First Line	:	65 ASPENGLOW BLVD UNIT 204
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9685
Country	:	US
Telephone Number	:	210-426-5764
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 CORNERSTONE DR
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-8156
Country	:	US
Telephone Number	:	970-570-5238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	05/23/2019

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