Basic Information
| Provider Information | |||||||||
| NPI: | 1043298235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORAH | ||||||||
| FirstName: | MARLENE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ELIZABETH PL STE 111 | ||||||||
| Address2: | 1195 B MEADOW BRIDGE DRIVE | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454081445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372280579 | ||||||||
| FaxNumber: | 9372280592 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ELIZABETH PL | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454081445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372280579 | ||||||||
| FaxNumber: | 9372280592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E0002155 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.