Provider Demographics
NPI:1114171261
Name:MIYATA, SHARON (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:MIYATA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 292169
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0037
Mailing Address - Country:US
Mailing Address - Phone:661-789-7449
Mailing Address - Fax:
Practice Address - Street 1:4 MAPLELEAF DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9208
Practice Address - Country:US
Practice Address - Phone:661-789-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7963106H00000X
101YM0800X
CA100799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health