Provider Demographics
NPI:1063538791
Name:SORRELL, DEIDRA ALEXANDER
Entity type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:ALEXANDER
Last Name:SORRELL
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 1:1282 SMALLWOOD DR W
Mailing Address - Street 2:STE #250
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4732
Mailing Address - Country:US
Mailing Address - Phone:240-461-1305
Mailing Address - Fax:
Practice Address - Street 1:1282 SMALLWOOD DR W
Practice Address - Street 2:STE #250
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4732
Practice Address - Country:US
Practice Address - Phone:240-461-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13819101YP2500X
MDLC2388101YP2500X
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional