Provider Demographics
NPI:1043298235
Name:SORAH, MARLENE A (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:A
Last Name:SORAH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELIZABETH PL STE 111
Mailing Address - Street 2:1195 B MEADOW BRIDGE DRIVE
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1445
Mailing Address - Country:US
Mailing Address - Phone:937-228-0579
Mailing Address - Fax:937-228-0592
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-228-0579
Practice Address - Fax:937-228-0592
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health