Provider Demographics
NPI:1265663504
Name:SMITH-WILBORN, SHARON SUZETTE (LMSW, LISAC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:SUZETTE
Last Name:SMITH-WILBORN
Suffix:
Gender:F
Credentials:LMSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4839 S DARROW DR
Mailing Address - Street 2:G162
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6684
Mailing Address - Country:US
Mailing Address - Phone:480-234-2404
Mailing Address - Fax:
Practice Address - Street 1:4839 S DARROW DR
Practice Address - Street 2:G162
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6684
Practice Address - Country:US
Practice Address - Phone:480-234-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMSW - 84411041C0700X
AZLISAC - 11665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical