Provider Demographics
NPI:1558507343
Name:SHARP, CAMMELLIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMMELLIA
Middle Name:A
Last Name:SHARP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SW 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2639
Mailing Address - Country:US
Mailing Address - Phone:405-692-5585
Mailing Address - Fax:
Practice Address - Street 1:1205 SW 93RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2639
Practice Address - Country:US
Practice Address - Phone:405-692-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical