Provider Demographics
NPI:1598958217
Name:ANCHAK, SHARON L (LPCC-S, LSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:ANCHAK
Suffix:
Gender:F
Credentials:LPCC-S, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 GATEWAY STE 204
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1891
Mailing Address - Country:US
Mailing Address - Phone:513-445-9959
Mailing Address - Fax:513-725-1276
Practice Address - Street 1:5720 GATEWAY STE 204
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1891
Practice Address - Country:US
Practice Address - Phone:513-445-9959
Practice Address - Fax:513-725-1276
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
OHS-7000391041C0700X
OHE 1100183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
13805829OtherCAQH
OH0166382Medicaid