Provider Demographics
NPI:1093911901
Name:BIJOU, SHARISE MONIQUE (MSA, MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARISE
Middle Name:MONIQUE
Last Name:BIJOU
Suffix:
Gender:F
Credentials:MSA, MSW, LCSW
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:M
Other - Last Name:BIJOUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2407 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1672
Mailing Address - Country:US
Mailing Address - Phone:316-207-0183
Mailing Address - Fax:
Practice Address - Street 1:2407 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1672
Practice Address - Country:US
Practice Address - Phone:316-207-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPSW22841041C0700X
VA09040145751041C0700X
KS51521041C0700X, 1041C0700X
AZ134891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical