Provider Demographics
NPI:1376336743
Name:SORG, AVA CARMEN
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:CARMEN
Last Name:SORG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 CORCUS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8207
Mailing Address - Country:US
Mailing Address - Phone:910-352-2946
Mailing Address - Fax:
Practice Address - Street 1:6740 ROCK SPRING RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3185
Practice Address - Country:US
Practice Address - Phone:910-390-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician