Provider Demographics
NPI:1376189241
Name:WHARTON, SHARON ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELAINE
Last Name:WHARTON
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 1:1916 ANDREW ALDEN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-7494
Mailing Address - Country:US
Mailing Address - Phone:303-359-0575
Mailing Address - Fax:
Practice Address - Street 1:703 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5996
Practice Address - Country:US
Practice Address - Phone:303-359-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09926192101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor