Provider Demographics
NPI:1538630199
Name:THORSON, SARRESA (LCSW)
Entity type:Individual
Prefix:
First Name:SARRESA
Middle Name:
Last Name:THORSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 EMMA BROWNING AVE
Mailing Address - Street 2:36TH SUSTAINMENT BRIGADE, HHC; SOCIAL WORK DEPT
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5102 EMMA BROWNING AVE
Practice Address - Street 2:36TH SUSTAINMENT BRIGADE, HHC; SOCIAL WORK DEPT
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3647
Practice Address - Country:US
Practice Address - Phone:210-381-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical