Provider Demographics
NPI:1760813364
Name:HALLIDAY, SHARON RAYNES (LCAS CCS CSARFD)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RAYNES
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:LCAS CCS CSARFD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 BEN FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2147
Mailing Address - Country:US
Mailing Address - Phone:919-667-6679
Mailing Address - Fax:919-471-5475
Practice Address - Street 1:4411 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2147
Practice Address - Country:US
Practice Address - Phone:919-667-6679
Practice Address - Fax:919-471-5475
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101Y00000X
NC20507101YA0400X
NC2015-010722084P0802X, 2084P0805X
NC2015010722084P0802X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry