Provider Demographics
NPI:1780878439
Name:LOR, SHOUA (ACSW)
Entity type:Individual
Prefix:
First Name:SHOUA
Middle Name:
Last Name:LOR
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971
Mailing Address - Country:US
Mailing Address - Phone:530-283-3330
Mailing Address - Fax:530-283-2150
Practice Address - Street 1:650 BETTY BELLE LANE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:530-345-1144
Practice Address - Fax:530-345-2073
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAACSW73055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health