Provider Demographics
NPI:1841798097
Name:SORRELL, MISTY CHERI (LICDC-CS, LSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:CHERI
Last Name:SORRELL
Suffix:
Gender:F
Credentials:LICDC-CS, LSW
Other - Prefix:MISS
Other - First Name:MISTY
Other - Middle Name:CHERI
Other - Last Name:ENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICDC-CS, LSW
Mailing Address - Street 1:436 WEATERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-309-3309
Mailing Address - Fax:
Practice Address - Street 1:436 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2343
Practice Address - Country:US
Practice Address - Phone:740-309-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162043101YA0400X
OHS.2106712104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker