Provider Demographics
NPI:1437146859
Name:WILCOX, SHARON Z (LMHE)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:Z
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-1559
Mailing Address - Country:US
Mailing Address - Phone:863-519-0575
Mailing Address - Fax:863-534-7028
Practice Address - Street 1:1835 GILMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3017
Practice Address - Country:US
Practice Address - Phone:863-248-3300
Practice Address - Fax:863-534-7028
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7045101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766780900Medicaid
FL79213000OtherMAGELLAN
FLZ0785OtherBLUE CROSS BLUE SHIELD