Basic Information
| Provider Information | |||||||||
| NPI: | 1790716124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SORG | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 FIVE MILE RD. #240 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132323070 | ||||||||
| FaxNumber: | 5132325794 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 FIVE MILE RD. #240 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132323070 | ||||||||
| FaxNumber: | 5132325794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | E0000318 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 000000011320 | 01 | OH | ANTHEM | OTHER |