Provider Demographics
NPI:1164168985
Name:STREETMAN-LOY, SHARON BLAIZ (PHD, LISW-CP)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:BLAIZ
Last Name:STREETMAN-LOY
Suffix:
Gender:F
Credentials:PHD, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 FAIRVIEW RD, STE H PMB 277
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680
Mailing Address - Country:US
Mailing Address - Phone:864-420-7083
Mailing Address - Fax:
Practice Address - Street 1:110 SYLVAN OAK WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2561
Practice Address - Country:US
Practice Address - Phone:864-420-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical