Provider Demographics
NPI:1205218567
Name:SHARPE, LEAH (AA, CADC I)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SHARPE
Suffix:
Gender:F
Credentials:AA, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SW 14TH ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9443
Mailing Address - Country:US
Mailing Address - Phone:503-298-9654
Mailing Address - Fax:503-325-2153
Practice Address - Street 1:1230 MARINE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4059
Practice Address - Country:US
Practice Address - Phone:503-325-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR13-12-39101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health