Provider Demographics
NPI:1164490900
Name:SHARP, PHILLIP M (EDD,)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:SHARP
Suffix:
Gender:M
Credentials:EDD,
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 3814
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0814
Mailing Address - Country:US
Mailing Address - Phone:910-313-0460
Mailing Address - Fax:910-452-7708
Practice Address - Street 1:219 RACINE DR STE A3
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-313-0460
Practice Address - Fax:910-452-7708
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2158103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2816173Medicare ID - Type Unspecified