Provider Demographics
NPI:1851497879
Name:SORENSON, VIRGINIA (LP LMFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:SORENSON
Suffix:
Gender:F
Credentials:LP LMFT
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP, LMFT
Mailing Address - Street 1:411 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1802
Mailing Address - Country:US
Mailing Address - Phone:612-385-1156
Mailing Address - Fax:
Practice Address - Street 1:411 BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-1802
Practice Address - Country:US
Practice Address - Phone:612-385-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1355103TC0700X
MN680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN702678100Medicaid