Provider Demographics
NPI:1659675825
Name:MAYBERRY, SHARRON ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:SHARRON
Middle Name:ELIZABETH
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 E OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3420
Mailing Address - Country:US
Mailing Address - Phone:619-889-5144
Mailing Address - Fax:760-796-7397
Practice Address - Street 1:829 E OHIO AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3420
Practice Address - Country:US
Practice Address - Phone:619-889-5144
Practice Address - Fax:760-796-7397
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor