Provider Demographics
NPI:1710388970
Name:SORRELL, LILLIE RUTH (LLPC)
Entity Type:Individual
Prefix:MS
First Name:LILLIE
Middle Name:RUTH
Last Name:SORRELL
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1818
Mailing Address - Country:US
Mailing Address - Phone:313-833-8100
Mailing Address - Fax:313-833-3393
Practice Address - Street 1:4250 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1818
Practice Address - Country:US
Practice Address - Phone:313-833-8100
Practice Address - Fax:313-833-3393
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional