Provider Demographics
NPI:1407079940
Name:MICHENER, SHARON LEE (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEE
Last Name:MICHENER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MAPLE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4562
Mailing Address - Country:US
Mailing Address - Phone:802-860-8345
Mailing Address - Fax:802-862-9339
Practice Address - Street 1:231 MAPLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4562
Practice Address - Country:US
Practice Address - Phone:802-860-8345
Practice Address - Fax:802-862-9339
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068000585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010830Medicaid