Provider Demographics
NPI:1093838096
Name:MEYER, SHARON COLLEEN (BS CADC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:COLLEEN
Last Name:MEYER
Suffix:
Gender:F
Credentials:BS CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23173 IL RT 185
Mailing Address - Street 2:
Mailing Address - City:MULBERRY GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:62262-3136
Mailing Address - Country:US
Mailing Address - Phone:618-326-8817
Mailing Address - Fax:
Practice Address - Street 1:101 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3506
Practice Address - Country:US
Practice Address - Phone:618-533-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21344101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)