Provider Demographics
NPI:1053833640
Name:FRAZIER, SHAROLYN OMEGA (MSW, LCSW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:SHAROLYN
Middle Name:OMEGA
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 CHASTAIN PARC DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7655
Mailing Address - Country:US
Mailing Address - Phone:919-749-2332
Mailing Address - Fax:
Practice Address - Street 1:648 S JONES AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5841
Practice Address - Country:US
Practice Address - Phone:919-749-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11631101YM0800X, 1041C0700X
NCC008245101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health