Provider Demographics
NPI:1417199613
Name:KEARSON, SHARON (LC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:KEARSON
Suffix:
Gender:F
Credentials:LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7504 REMOOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4567
Mailing Address - Country:US
Mailing Address - Phone:410-594-0888
Mailing Address - Fax:410-594-0741
Practice Address - Street 1:7504 REMOOR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4567
Practice Address - Country:US
Practice Address - Phone:410-594-0888
Practice Address - Fax:410-594-0741
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406597200Medicaid