Provider Demographics
NPI:1255001939
Name:LEUKERT, SHARON DARLENE (MA MFT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DARLENE
Last Name:LEUKERT
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DARLENE
Other - Last Name:NORVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2950 HALCYON LN STE 605
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6692
Mailing Address - Country:US
Mailing Address - Phone:904-302-5340
Mailing Address - Fax:
Practice Address - Street 1:2950 HALCYON LN STE 605
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6692
Practice Address - Country:US
Practice Address - Phone:904-302-5340
Practice Address - Fax:904-800-1211
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist