Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | LC2388 | MD |
N | 101YP2500X | Professional Counselor | PRC13819 | DC |
Y | 103TS0200X | School Psychologist | DC |
NPI | 1063538791 |
---|---|
Provider Name | Mrs. Deidra Alexander Sorrell |
First Address | Waldorf, MD 20603-4732 |
Second Address | Waldorf, MD 20603-4732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 16/10/2013 |