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1962861401
THOMAS WAYNE SORRELLS
ROSEBURG, OR
NPI
1962861401
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
Enumeration Date
2016-02-12
Last Update Date
2016-02-12
Business Address
MR. THOMAS WAYNE SORRELLS CSWA
548 SE JACKSON ST
ROSEBURG, OR 97470-2709
Phone number: 541-672-2691
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Mailing Address
MR. THOMAS WAYNE SORRELLS CSWA
PO BOX 1121
ROSEBURG, OR 97470-0254
Phone number: 541-672-2691
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