Provider Demographics
NPI:1396214649
Name:CARROLL, SHARON MARIE (NAC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-5327
Mailing Address - Country:US
Mailing Address - Phone:360-770-7852
Mailing Address - Fax:
Practice Address - Street 1:2735 10TH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1413
Practice Address - Country:US
Practice Address - Phone:425-258-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health