Provider Demographics
NPI:1477196814
Name:ADAMS, SHARON (SUDP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 SELAH LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-8819
Mailing Address - Country:US
Mailing Address - Phone:509-881-9148
Mailing Address - Fax:
Practice Address - Street 1:307 S 12TH AVE STE 4B
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3137
Practice Address - Country:US
Practice Address - Phone:509-575-8457
Practice Address - Fax:509-453-1273
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60927121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid