Provider Demographics
NPI:1275632119
Name:SHARITT, CYNTHIA DICKSON (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DICKSON
Last Name:SHARITT
Suffix:
Gender:F
Credentials:LCSW
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 5771
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-0771
Mailing Address - Country:US
Mailing Address - Phone:423-205-9057
Mailing Address - Fax:
Practice Address - Street 1:3169 2ND AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3805
Practice Address - Country:US
Practice Address - Phone:276-523-8300
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0035401041C0700X
VA09040084061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical