Provider Demographics
NPI:1033356704
Name:TOLIVER-HARDY, SHARON KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:TOLIVER-HARDY
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 1:325 MOUNTAIN AVENUE SW
Mailing Address - Street 2:STE 2
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4044
Mailing Address - Country:US
Mailing Address - Phone:540-580-0310
Mailing Address - Fax:945-202-3627
Practice Address - Street 1:325 MOUNTAIN AVENUE SW
Practice Address - Street 2:STE 2
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4044
Practice Address - Country:US
Practice Address - Phone:540-580-0310
Practice Address - Fax:945-202-3627
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001076101Y00000X
VA09040070161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205815420Medicaid