Provider Demographics
NPI:1124536602
Name:SHARP, LAUREL J (MA, PHD(ABD))
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:J
Last Name:SHARP
Suffix:
Gender:F
Credentials:MA, PHD(ABD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NEVADA WAY
Mailing Address - Street 2:
Mailing Address - City:OLIVEHURST
Mailing Address - State:CA
Mailing Address - Zip Code:95961-7467
Mailing Address - Country:US
Mailing Address - Phone:530-713-9742
Mailing Address - Fax:
Practice Address - Street 1:735 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4568
Practice Address - Country:US
Practice Address - Phone:916-748-1771
Practice Address - Fax:916-748-2288
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health