Provider Demographics
NPI:1992068134
Name:HUMES-AUSTIN, LORRITA P (LCSW)
Entity type:Individual
Prefix:
First Name:LORRITA
Middle Name:P
Last Name:HUMES-AUSTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:105 HOSPITAL RD
Mailing Address - Street 2:TUOLUMNE COUNTY BEHAVIORAL HEALTH
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5227
Mailing Address - Country:US
Mailing Address - Phone:209-533-6245
Mailing Address - Fax:209-588-9528
Practice Address - Street 1:105 HOSPITAL RD
Practice Address - Street 2:TUOLUMNE COUNTY BEHAVIORAL HEALTH
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5227
Practice Address - Country:US
Practice Address - Phone:209-533-6245
Practice Address - Fax:209-588-9528
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS10294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker