Provider Demographics
NPI:1073714036
Name:HARTZOG, SHARON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:HARTZOG
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 1:418 STAR RUBY DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7236
Mailing Address - Country:US
Mailing Address - Phone:919-455-6532
Mailing Address - Fax:919-217-1820
Practice Address - Street 1:418 STAR RUBY DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545
Practice Address - Country:US
Practice Address - Phone:919-266-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical