Provider Demographics
NPI:1689143695
Name:BASS, SHARESSA M
Entity Type:Individual
Prefix:
First Name:SHARESSA
Middle Name:M
Last Name:BASS
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 1:3515 ARSENAL CT APT 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3997
Mailing Address - Country:US
Mailing Address - Phone:704-287-1584
Mailing Address - Fax:
Practice Address - Street 1:3515 ARSENAL CT APT 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3997
Practice Address - Country:US
Practice Address - Phone:704-287-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional