Provider Demographics
NPI:1417559501
Name:SHARPE, SHA-DE' R (LPC)
Entity Type:Individual
Prefix:
First Name:SHA-DE'
Middle Name:R
Last Name:SHARPE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 IVY FORK LN
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5857
Mailing Address - Country:US
Mailing Address - Phone:678-860-8798
Mailing Address - Fax:
Practice Address - Street 1:2042 IVY FORK LN
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5857
Practice Address - Country:US
Practice Address - Phone:678-860-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional