Active NPI
Deidra Alexander Sorrell
- School Psychologist
- Waldorf, MD
National Provider Identifier
1063538791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 1282 Smallwood Dr W
Ste #250
Waldorf, MD 20603-4732 - Phone
- (240) 461-1305
- NPI assigned
- Mar 22, 2007
- Last updated
- Oct 16, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PRC13819 | DC | |
| Professional Counselor | 101YP2500X | LC2388 | MD | |
| School Psychologist | 103TS0200X | DC | Primary |
Addresses
Primary practice location
1282 Smallwood Dr W
Ste #250
Waldorf, MD 20603-4732
Mailing address
1282 Smallwood Dr W
Ste #250
Waldorf, MD 20603-4732
Phone (240) 461-1305
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PRC13819 | DC | MD | Professional Counselor |
| LC2388 | MD | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Synergy Wellness Therapeutic Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Waldorf, MD
- NPI 1417517939
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381881600000",
"number": "1063538791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1282 SMALLWOOD DR W",
"address_2": "STE #250",
"city": "WALDORF",
"state": "MD",
"postal_code": "206034732",
"telephone_number": "240-461-1305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1282 SMALLWOOD DR W",
"address_2": "STE #250",
"city": "WALDORF",
"state": "MD",
"postal_code": "206034732",
"telephone_number": "240-461-1305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SORRELL",
"first_name": "DEIDRA",
"middle_name": "ALEXANDER",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2013-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "DC",
"license": "PRC13819",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC2388",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "DC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
- Solace Clinical Services
- Solutions Counseling and Education Services, Inc.
- Solutions of Healthcare LLC
- Somo Urgent Care, Inc
- Somo Urgent Care, Inc
- Rachael Courduff Sottile
- Southern Maryland Chiropractic Center David E. Kane PC
- Southern Maryland Community Network Inc
- Southern Maryland Community Network Inc
- Southern Maryland Community Network, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.