Provider Demographics
NPI:1659420388
Name:GARDNER, SHAARON GAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAARON
Middle Name:GAIL
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 HONEYHILL LN
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-6763
Mailing Address - Country:US
Mailing Address - Phone:828-894-0486
Mailing Address - Fax:
Practice Address - Street 1:182 W COURT ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2805
Practice Address - Country:US
Practice Address - Phone:828-287-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102691103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical