Provider Demographics
NPI:1497159479
Name:BRANUM, SHARINA NICOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:SHARINA
Middle Name:NICOLE
Last Name:BRANUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N HWY 360 # H3088
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2555
Mailing Address - Country:US
Mailing Address - Phone:817-896-1173
Mailing Address - Fax:
Practice Address - Street 1:1050 N HWY 360 # H3088
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2555
Practice Address - Country:US
Practice Address - Phone:817-896-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36526103K00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker