Provider Demographics
NPI:1407191067
Name:SORENSEN, MARIA ANTONIETA (M C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONIETA
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:M C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ANTONIETA
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M C
Mailing Address - Street 1:5543 N PALO VERDE VISTA PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-8610
Mailing Address - Country:US
Mailing Address - Phone:520-235-0765
Mailing Address - Fax:
Practice Address - Street 1:210 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2514
Practice Address - Country:US
Practice Address - Phone:866-836-1688
Practice Address - Fax:520-876-1796
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 13664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional