Provider Demographics
NPI:1629777032
Name:SORTELLI, JOANNA SUE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:SUE
Last Name:SORTELLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 AFFINITY DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-5003
Mailing Address - Country:US
Mailing Address - Phone:619-436-9647
Mailing Address - Fax:
Practice Address - Street 1:564 AFFINITY DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-5003
Practice Address - Country:US
Practice Address - Phone:619-436-9647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist