Provider Demographics
NPI:1598976383
Name:DAVIS, SHARON DIANE (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DIANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1555
Mailing Address - Country:US
Mailing Address - Phone:409-770-0668
Mailing Address - Fax:
Practice Address - Street 1:2622 MARKET ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1433
Practice Address - Country:US
Practice Address - Phone:713-373-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8564101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)