Provider Demographics
NPI:1346967585
Name:QUACKENBUSH, SHARON (MA, NCC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:QUACKENBUSH
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 HARRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3822
Mailing Address - Country:US
Mailing Address - Phone:850-510-5298
Mailing Address - Fax:
Practice Address - Street 1:PROGRESS COUNSELING GROUP
Practice Address - Street 2:213 SOUTH DILLARD STREET SUITE 120B
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:407-734-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health