Provider Demographics
NPI:1326193079
Name:LAKE, SHARON ANN (LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:LAKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ANN BAILEY
Other - Last Name:HAMLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8230 KIP CT.
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3245
Mailing Address - Country:US
Mailing Address - Phone:907-244-8872
Mailing Address - Fax:907-563-3217
Practice Address - Street 1:2509 EIDE ST.
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-244-8872
Practice Address - Fax:907-563-3217
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
AK614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPENDINGMedicaid