Provider Demographics
NPI:1730307349
Name:SORRELL, CHRISTY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:
Last Name:SORRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5831
Mailing Address - Country:US
Mailing Address - Phone:865-983-1899
Mailing Address - Fax:865-233-0465
Practice Address - Street 1:339 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5831
Practice Address - Country:US
Practice Address - Phone:865-983-1899
Practice Address - Fax:865-233-0465
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103TS0200X
TN2584103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520407Medicaid