Provider Demographics
NPI:1215495122
Name:LORELLE, SONYA (PHD)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:LORELLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W BELMONT AVE REAR 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5458
Mailing Address - Country:US
Mailing Address - Phone:757-613-2168
Mailing Address - Fax:
Practice Address - Street 1:3535 W BELMONT AVE REAR 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5458
Practice Address - Country:US
Practice Address - Phone:757-613-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004351101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor