Provider Demographics
NPI:1245402668
Name:WINDFREY, SHARON (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WINDFREY
Suffix:
Gender:F
Credentials:PHD
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 760224
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2511
Mailing Address - Country:US
Mailing Address - Phone:248-891-9094
Mailing Address - Fax:888-492-9386
Practice Address - Street 1:17348 W. 12 MILE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2511
Practice Address - Country:US
Practice Address - Phone:888-492-9386
Practice Address - Fax:888-492-9386
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005866103TC1900X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling