Provider Demographics
NPI:1093281602
Name:PHELAN, SHARON VERONICA (LCSWA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:VERONICA
Last Name:PHELAN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-3530
Mailing Address - Country:US
Mailing Address - Phone:336-880-3534
Mailing Address - Fax:
Practice Address - Street 1:240 GRANDFATHER HOME DRIVE
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-2860
Practice Address - Country:US
Practice Address - Phone:828-898-5464
Practice Address - Fax:828-898-8513
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0119791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical