Provider Demographics
NPI:1528587607
Name:SHARP, NICHOLAS (LCDCIII)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:SHARP
Suffix:
Gender:M
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 CHARLEVOIX AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-9466
Mailing Address - Country:US
Mailing Address - Phone:740-542-0648
Mailing Address - Fax:
Practice Address - Street 1:151 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1742
Practice Address - Country:US
Practice Address - Phone:740-286-1889
Practice Address - Fax:740-286-1887
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)