MEDICARE: CAROLYN SORENSON BS

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	106E00000X	Assistant Behavior Analyst		SC

General Provider Information

NPI Number	:	1871013508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN SORENSON BS

Provider Business Mailing Address
First Line	:	2218 HUNTER CREEK DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-6707
Country	:	US
Telephone Number	:	843-568-3273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2218 HUNTER CREEK DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414
Country	:	US
Telephone Number	:	843-568-3273
Fax Number	:

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

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	07/21/2022

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