Provider Demographics
NPI:1063485993
Name:WIERENGA, SHARON A (MA LCPC, LPCC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:WIERENGA
Suffix:
Gender:F
Credentials:MA LCPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 MARSEILLES WAY
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1417
Mailing Address - Country:US
Mailing Address - Phone:708-254-8999
Mailing Address - Fax:
Practice Address - Street 1:2439 MARSEILLES WAY
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1417
Practice Address - Country:US
Practice Address - Phone:708-254-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005274101YP2500X
CA2132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional