Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LH60129957 | WA |
NPI | 1053637751 |
---|---|
Provider Name | Ms. Carol Johnson Sorenson |
First Address | Olympia, WA 98501-1655 |
Second Address | Olympia, WA 98501-1655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 20/04/2010 |