Provider Demographics
NPI:1417430323
Name:RICHARDSON, SHARON DENISE (LPC-MHSP, CRC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPC-MHSP, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6634 BIRCH RUN LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-5208
Mailing Address - Country:US
Mailing Address - Phone:901-216-1226
Mailing Address - Fax:901-368-4315
Practice Address - Street 1:6634 BIRCH RUN LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5208
Practice Address - Country:US
Practice Address - Phone:901-216-1226
Practice Address - Fax:901-368-4315
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003867101Y00000X, 101YM0800X, 101YP2500X
101Y00000X
00174823225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor