Provider Demographics
NPI:1083968580
Name:COLLINS, SHARON THOMAS (LCAS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:THOMAS
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 PEBBLE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5679
Mailing Address - Country:US
Mailing Address - Phone:919-607-6998
Mailing Address - Fax:
Practice Address - Street 1:2643 PEBBLE MEADOW LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5679
Practice Address - Country:US
Practice Address - Phone:919-607-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)