Provider Demographics
NPI:1083783534
Name:HEASTON, SHARON DEE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DEE
Last Name:HEASTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W 4TH ST REAR BUILDING
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4710
Mailing Address - Country:US
Mailing Address - Phone:909-945-8894
Mailing Address - Fax:909-945-2855
Practice Address - Street 1:237 W 4TH ST REAR BUILDING
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:909-945-8894
Practice Address - Fax:909-945-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist