Provider Demographics
NPI:1508814096
Name:SHARON M. KIRKLAND, INC.
Entity Type:Organization
Organization Name:SHARON M. KIRKLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:863-619-6555
Mailing Address - Street 1:6700 S FLORIDA AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3327
Mailing Address - Country:US
Mailing Address - Phone:863-619-6555
Mailing Address - Fax:863-619-6555
Practice Address - Street 1:6700 S FLORIDA AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3311
Practice Address - Country:US
Practice Address - Phone:863-619-6555
Practice Address - Fax:863-619-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 19151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS22990Medicare UPIN
FLZ4944ZMedicare NSC
FLK7708Medicare ID - Type UnspecifiedGROUP ID NUMBER