Provider Demographics
NPI:1336478536
Name:SORG-HATCH, PAMELA (PC, CR)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SORG-HATCH
Suffix:
Gender:F
Credentials:PC, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6797 N. HIGH STREET
Mailing Address - Street 2:SUITE 155
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085
Mailing Address - Country:US
Mailing Address - Phone:614-338-5716
Mailing Address - Fax:
Practice Address - Street 1:6797 N HIGH ST
Practice Address - Street 2:SUITE 155
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2533
Practice Address - Country:US
Practice Address - Phone:614-338-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0008424-CR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional