Provider Demographics
NPI:1871689547
Name:SORENSEN, DAVID ALAN (EDD, LPCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:EDD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 R COORS RD. NW
Mailing Address - Street 2:STE. 265
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:505-440-3512
Mailing Address - Fax:505-254-3574
Practice Address - Street 1:2202 MENAUL NE
Practice Address - Street 2:STE. A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-440-3512
Practice Address - Fax:505-254-3574
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB9422Medicaid