Provider Demographics
NPI:1508214370
Name:SORENSEN, DAVID (LPC-IT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8073 S CHAPEL HILL DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2429
Mailing Address - Country:US
Mailing Address - Phone:414-810-9073
Mailing Address - Fax:
Practice Address - Street 1:8073 S CHAPEL HILL DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-2429
Practice Address - Country:US
Practice Address - Phone:414-810-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7143-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3026-226OtherWISCONSIN LICENSED PROFESSIONAL COUNSELOR LICENSE