Provider Demographics
NPI:1417578220
Name:SHARP, DEIDRE V (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEIDRE
Middle Name:V
Last Name:SHARP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 IVY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8793
Mailing Address - Country:US
Mailing Address - Phone:901-337-1515
Mailing Address - Fax:
Practice Address - Street 1:8142 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2029
Practice Address - Country:US
Practice Address - Phone:901-337-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2579103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling